Oncologic Emergencies Flashcards
State 4 causes of metabolic oncologic emergencies
Tumor lysis syndrome
Hypercalcemia
Hyponatremia
Hypoglycemia
State the electrolyte imbalance in TLS x4
Hyperphosphatemia, hyperkalemia, hyperuricemia
Hypocalcemia
Solid tumors that can cause TLS x4
Melanoma
Germ cell tumors
Small cell lung cancer
Inflammatory breast cancer
Acute TLS treatment x5
- Stop chemo
- Aggressive IV fluids
- Potassium shifting
- Emergency hemodialysis
- Allopurinol for prevention of hyper uricemia
Malignant causes of hypercalcemia x5
Breast
Lung
Renal CC
Multiple myeloma
Adult T-cell lymphoma/leukemia
Steps involved in potassium shifting x4
- Calcium gluconate to stabilize the cardiac muscles
- Give dextrose and insulin
- Salbutamol promotes K uptake by cells
- Kayexalate prevents K uptake in the GIT
Describe 4 ways in which tumors can cause hypercalcemia
- Systemic release of parathyroid hormone related peptide by the tumor
- Systemic secretion of vitamin D analogues
- Penetration into bone > bone resorption
- Local stimulation of osteoclasts > osteolytic activity
Presentation of hypercalcemia x4
Skeletal pain
Nephrolithiasis
Abdominal discomfort
Altered mental state, reduced LOC
Differential diagnosis for SIADH x2
Adverse effects of cytotoxic chemotherapy agents
Ectopic production of atrial natriuretic factor
Causes of hyponatremia
SIADH
Small cell lung cancer
Clinical symptoms of mild hyponatremia x5
Fatigue
Headache
Memory loss
Impaired abstract thinking
Subtle mental status
Clinical symptoms of severe hyponatremia x5
Confusion
Seizures
Coma
Asterixis
Altered mental status
Treatment of hyponatremia x3
Fluid restriction or induced diuresis
Demeclocycline to prevent sensitivity to ADH
3% hypertonic saline to treat seizures or coma
Treatment of cardiac tamponade x3
Pericardiocentesis
Drainage from sac through catheter
Pericardial stripping ie pericardiectomy
Cancers associated with superior vena cava syndrome x5
Lung cancer - right
Breast cancer
Thymoma
Lymphoblastic lymphoma
Primary mediastinal lymphoma
Causes of neutropenic sepsis x2
Cancers direct interference with hematopoiesis
Side effect of cytotoxic therapy about 10 days after last dose
Areas where spinal cord compression can occur x3
Posterior extension of the vertebral body
Vertebral foramen
Define fundus paraproteinaemicus
Dilated engorged veins that resemble sausage links on ophthalmologic exam in Hyperviscosity
Clinical consequences of Hyperviscosity x3 per system
Congestive cardiac failure
Pulmonary edema
Ischemic acute tubular necrosis
Define kussmauls signs
Paradoxical rise in JVP during inspiration
Laboratory findings for Hyperviscosity x5
Thrombocytopenia
Rouleaux formation
Iron deficiency anemia
Renal dysfunction with azotemia
Elevated RBC mass in relation to the blood volume
Diseases that predispose patients to leukostasis x2
AML
CML in blast crisis
Causes of tissue damage in hyperleukocytosis syndrome x3
Local hypoxia caused by blast cell consumption of O2
Hyperpermeability - blast cell invasiveness
Release of lysosomes and procoagulants
