Podcast #396: Oncologic Emergencies

Author: Rachel Brady, MD

Educational Pearls:

Hypercalcemia of malignancy:

  • Hypercalcemia of malignancy can present with lethargy, muscle weakness, hyperreflexia, altered mental status, cardiac dysrhythmias, and even cardiac arrest.
  • Treatment is based both on calcium level and symptoms
  • Intravenous rehydration is first line treatment
  • Other options include steroids, bisphosphonates and calcitonin.

Tumor Lysis Syndrome

  • Occurs due to the breakdown of tumor cells after chemotherapy/radiation
  • Presents as hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia
  • Treatment is very similar to severe hypercalcemia – hydration with crystalloids
  • Hyperuricemia can be treated using rasburicase or allopurinol

 

References:

Ñamendys-Silva SA, Arredondo-Armenta JM, Plata-Menchaca EP, Guevara-García H, García-Guillén FJ, Rivero-Sigarroa E, Herrera-Gómez A. Tumor lysis syndrome in the emergency department: challenges and solutions. Open Access Emerg Med. 2015 Aug 20;7:39-44. doi: 10.2147/OAEM.S73684. eCollection 2015. Review. PubMed PMID: 27147889; PubMed Central PMCID: PMC4806807.

Zagzag J, Hu MI, Fisher SB, Perrier ND. Hypercalcemia and cancer: Differential diagnosis and treatment. CA Cancer J Clin. 2018 Sep;68(5):377-386. doi: 10.3322/caac.21489. Epub 2018 Sep 21. Review. PubMed PMID: 30240520.

 

Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

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