Neutropenic sepsis Flashcards
Definition of neutropenic sepsis
fever >38 degrees for 1 hours
neutrophil count < or equal to 0.5 or < or equal to 1 and falling
who is at risk of neutropenic sepsis
anyone who has had chemotherapy within 6 weeks of presentation is at risk
urgent administration of AB in:
patients with known or suspected neutropenia <1
temperature - > 38 or above on single occasion and <36 in an unwell pt, pyrexial but unwell with signs / symptoms of sepsis
management of neutropenic sepsis
broad spectrum AB within 1 hour - don’t wait for cultures
Sepsis 6:
give AB, o2, IV fluids
take lactate, urine output, blood cultures
remember if Hickman lines need swabs and cultures from there!
symptoms of hypercalcaemia
no symptoms or subtle nausea and vomiting thirst and polydipsia polyuria clinical dehydration agitation and confusion palpations
levels >3.5 will lead to psychosis and fatal arrhythmias
most common cause of hypercalcaemia in cancer patients
bone mets - especially breast, prostate and myeloma
paraneoplastic syndrome - seen especially in squamous carcinomas e.g. lung, head and neck and cervix
how to manage hypercalcaemia
ECG - may see short QT, ventricular arrhythmia possible in extreme hypercalcaemia
IV fluids - normal saline 2-3L
bisphosphonates: IV zolendronic acid - dose dependant on renal function, may not be required if asymptomatic
antiemetics
review medication
calcium levels take several days to fall, continue fluids, check electrolytes daily
what to consider when deciding to treat hypercalcaemia
patient and biochemistry
severity of symptoms, evidence of dehydration - patient
corrected calcium level and renal function - biochemistry
not always appropriate to treat hypercalcaemia
if asymptomatic and calcium <3 fluids may be enough
symptoms of hypersensitivity reaction to chemotherapy
fever, hypotension, tachycardia, low oxygen, wheeze, oropharyngeal oedema, anaphylaxis
management of hypersensitivity
stop infusion o2 IV fluids - stat antihistamine 10mg chlorphreniramine stat IV steroid - hydrocortisone 200mg adrenaline 0.5 of 1:1000 IM consider salbutamol / adrenaline nebs
what is tumour lysis syndrome
rapid tumour kill by effective therapy
releases contents into extracellular compartment/blood stream
risk factors for tumour lysis syndrome
treatment of bulky (>10cm) chemo sensitive diseases e.g. germ cell, SCLC, high grade lymphoma, acute leukaemia
treatment includes any anticancer therapy, even steroids in haematological cancer
preexisiting renal impairment/malignant biochemical abnormalities increase risk
diagnosis of tumour lysis syndrome
hyperuricaemia
hyperkalaemia
hyperphosphataemia/hypocalcaemia
renal failure
prevention is better than treatment for tumour lysis syndrome
IV fluids
prophylactic allopurinol or raburicase
twice daily biochemistry with physician review
correct abnormalities, lots of IV fluids
discuss with renal team/critical care if tumour lysis syndrome established
