Exam 2: Oncologic Emergency Flashcards
Metabolic emergencies
- HCM
- TLS
Neurologic emergencies
Spinal Cord Compression
CV Emergencies
- Superior vena cava syndrome
- Malignant pericardial effusion
- cardiac tamponade
Pulmonary Emergencies
pleural effusions
Infectious Emergencies
Neutropenic Fever
What is TLS
- metabolic derangements resulting from the death of malignant cells
- massive release of intracellular contents into the blood stream that overwhelms the body’s homeostasis
Drugs to increase uric acid
- aspirin
- alcohol
- thiazide diuretics
- caffeine
TLS Patho
- hyperkalemia exacerbated by AKI
- hyperuricemia –> AKI
- hyperphosphpatemia exacerbates aKI
- hypocalcemia
Acute renal failure
- 48-72 hours after initiation of therapy
TLS principles of managements
- identify high risk patients
- monitoring electrolytes
- aggressive hydration
- control of hyperuricemia
Low Risk Malignancy TLS
- most solid tumors
- myeloma
- indolent lymphomas
- chronic myeloid leukemia
Low Risk Malignancy TLS Treatment
- monitoring
- hydration ± allopurinol
Intermediate Risk TLS Malignancies
- DLBCL
- SCLC
Intermediate Risk TLS Prophylaxis
- monitoring
- hydration ± allopurinol
High Risk TLS Malignancies
- Burkitt’s lymphoma
- Lymphoblastic lymphomas
- most acute leukemis
High Risk TLS Prophylaxis
- monitoring
- hydration
- rasburicase
TLS: Aggressive hydration
- improves intravascular volume, renal perfusion, and GFR
- decrease risk of life-threatening hyperkalemia
- may require use of diuretics
Urine output maintenace in TLS
- 80-100 mL/m2/hr
- may require diuretics
TLS Hyperuricemia MGMT
- start at least 12-24 hours prior to chemo
- may require renal adjustment
- allopurinol until normalization of uric acid and other lab values
Limitations of allopurinol
- does not reduce already formed uric acid
- may take several days to lower uric acid
- decreases clearance of 6TMP, azathioprine, high dose MTX
Rasburicase
- decreases uric acid including already formed uric acid within 4 hours
- CI in women pregnant or breast-feeding
- expensive
-GTPD deficiency
TLS Hyperkalemia MGMT
Mild
- give IV fluids and loop
- SPS
Sever ≥6
- C A BIG K DROP
Hyperphosphatemia TLS MGMT
- minimize phosphate intake
- phosphate binder
Hypocalcemia TLS MGMT
- do not treat as asymptomatic
- small amounts and slow admin of IV calcium gluconate
- usually corrects itself after hyperphos is corrected
TLS Monitoring prior to initiation of certain chemo
- uric acid
- phos
- K
- Ca
- LDH
-SCr - urine output
TLS monitoring during first 72 hours after chemo initiation
- uric acid, phos, K, Ca, SCr q8
- patients receiving rasburicase: uric acid 4-8 hrs after dose
What is essential in MSCC
early diagnosis and treatment are essential to prevent permanent neurologic damage and possible paralysis
MSCC Symptoms
- pain
- motor deficit rapid onset
- sensory deficit
- autonomic dysfunction (bladder and bowel)
MSCC Patho
- development of compression in the spinal column from tumor cells
- destruction of cortical bone by tumor compound –? caused by cytokines, inflammatory markers, and neurotransmitters
MSCC Diagnoses
- MRI of whole spine
MSCC Treatment
- dexamethasone immediately
- surgery and radiotherapy leads to immediate relief
MSCC Treatment Bisphosphonates
- should be offered in patients with vertebral involvement to reduce risk of vertebral fracture/collapse
SVC Syndrome
- thin walled SVC gradually compressed by tumors outside the vessel
- impaired venous drainage the head, neck, and upper extremities
- occurs in the setting of an extrinsic compression or other occlusion of the superior vena cava
SVC Syndrome Treatment
- elevation of head
- steroids
- diuretics
- resection
- stenting
- anticoag
- radiation
- chemo
MPE
- accumulation of fluid in the pleural space
MPE Mgmt
- thoracentesis
- pleural fluid analysis
