Oncologic emergencies Flashcards
Tumor Lysis Sydrome
Metabolic derangement resulting from the death of malignant cells
What?–> massive release of intracellular contents into blood overwhelm body’s hemostasis
When?–>1-5 days following treatment
Where?–> Lymphoma and leukemia
Risk factors
High tumor burden, high tumor grade with rapid tumor turnover, treatment sensitive to tumors
Age, preexisting renal impairment, medications (ASA, alcohol, caffeine, thiazide)
Hyperkalemia
Immediate (6-72 hours after therapy)
Exacerbated by AKI
Effects: arrhythmia’s, EKG abnormalities
Hyperuricemia
Immediate (24-48 hours after therapy)
Purine catabolism–>hypoxanthine–>xanthine–>xanthine oxidase–>uric acid–>urate oxidase–>allantoin
Effect: AKI
Hyperphosphatemia
Immediate (24-48 hours after therapy)
Calcification with calcium
Effect: AKI
Hypocalcemia
Immediate (24-48 hours after therapy)
Acute renal failure
Delayed (48-72 hours after therapy)
Fluid overload, edema, CHF, seizures
Treatment
Identify high risk patients
Monitor electrolytes
Hyperkalemia: > 6 mEq/L–> CA BIG K DROP
Hyperphosphatemia: Sevelamer TID with meals
Hypocalcemia: symptomatic–>calcium gluconate
Aggressive hydration:
D5W + 1/2 NS +/- diuretics
Maintain urine output of 80-100 mL/m^2/hr
Hyperuricemia low risk
Baseline uric acid: < 7.5 mg/dL
Baseline WBC: < 25,000
Baseline LDH: <2X UNL
Prophylaxis: Monitoring + hydration +/- allopurinol
Hyperuricemia intermediate risk
Baseline uric acid: <7.5 mg/dL
Baseline WBC: 25,000-100,000
Baseline LDH: >2X UNL
Prophylaxis: monitoring + hydration + allopurinol
Hyperuricemia high risk
Baseline uric acid: > 7.5 mg/dL
Baseline WBC: >100,000
Baseline LDH:> 2x UNL
Prophylaxis: monitoring +hydration + rasburicase
Monitoring prior to chemo
potassium
calcium
phosphate
uric acid
SCr
urine output
LDH
Monitoring during first 72 hours
Potassium
calcium
phosphate
uric acid
SCr every 8 hours
Rasburicase: uric acid 4-8 hours
Malignant spinal cord compression
EMERGENCY
What?–> compression of the dural sac, spinal cord, or cauda equina by extradural or intradural mass and edema and cytokines that can lead to irreversible neurologic damage
Where?–> prostate, breast, lung
Symptoms of Malignant spinal cord compression
Pain
Limb weakness, unsteady gait, difficulty walking, standing, transferring
Decreased sensation and numbness of toes/fingers
Urinary retention, incontinence, constipation
