Oncological Emergencies Flashcards
Describe how neutropenic sepsis can present
Recently received chemotherapy (post 7-10 days) Temperature (or none) Confusion - impaired MMSE Cold and clammy Hypotension < 90 Tachycardia Tachypnoea May have indication of source of infection e.g. Cough
What factors increase the risk of neutropenic sepsis?
Prolonged and severe Neutropenia Cormorbidities Central lines Mucosal disruption Inpatient
What is gut translocation?
Movement of gut organisms into the bloodstream. Occurs when mucositis opens channels in the GI lining - leaky gut.
What are the commonest pathogens responsible for neutropenic sepsis?
Gut anaerobes - “polymicrobial until proven otherwise”. 80%
Increasing frequency of gram +ve cocci - indwelling plastic catheters promote colonisation - Staph aureus, staph epidermidis
What is significant Neutropenia?
0.5 x 10(9)/L
Define metastatic spinal cord compression
Collapse or compression of a vertebral body that contains metastatic disease (arterial seeding).
May also be compression directly from a tumour.
What medication would you prescribe for MSCC?
Dexamethasone 16mg + PPI
Analgesia
What are the risk factors for tumour lysis syndrome?
Renal dysfunction
Dehydration/hypovolemia
Chemotherapy - haematological malignancies and bulky chemoreceptive tumours
Pre-treatment high LDH or hyperuricaemia
What are the laboratory findings for tumour lysis syndrome?
Hyper - kalemia, phosphataemia, uricaemia
Hypocalcaemia
How CNS tumour lysis syndrome cause AKI?
Uric acid and/or calcium phosphate crystals lodge in renal tubules.
What causes tumour lysis syndrome?
Rapid cell death. Usually on starting chemotherapy for rapidly proliferating haematological malignancies and some germ cell tumours.
Describe the patient presenting with tumour lysis syndrome.
3-7 days post chemotherapy with nausea and vomiting. Not eating (anorexia), feeling tired (lethargy) and 5 episodes of Diarrhoea.
Others: haematuria, heart failure, arrhythmia
