Oncologic emergencies: a review

Abstract

Cancer and its treatment include many medical emergencies. Hence taking care of these emergencies presents a challenge not only to the clinicians but also to the medical oncologists. Cancer patients may have complex medical problems in addition to cancer such as coronary heart diseases, diabetes mellitus, and respiratory diseases. Such patients require immediate medical assistance and emergency care facilities to improvise their health condition. The present review paper focuses on more commonly confronted emergencies in cancer patients and their related management.Keywords: Hyperviscosity syndrome, Hemostatic emergencies, Oncologic emergencies, Tumor lysis syndrome, SIADH DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181492Baruah M. Int J Res Med Sci. 2018 May;6(5):1484-1490 International Tumor lysis syndrome (TLS)TLS results from destruction of large number of rapidly multiplying cells as a result of cancer induction chemotherapy but can also be seen after treatment with radiotherapy, corticosteroids, and hormonal agents such as tamoxifen, biological agents such as Interferon or spontaneously in patients with high tumor burden. This syndrome is associated with severe electrolyte abnormalities, hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, lactic acidosis and can lead to acute renal failure. 5 No specific signs and symptoms are noted for this syndrome. Symptoms may advance in line with electrolyte disturbances that include muscle weakness, arrhythmias, neuromuscular irritability, seizures and sudden death. 6 The main cause of mortality in these patients was arrhythmia associated with electrolyte disturbances, predominantly hyperkalemia and renal failure. 7 Hence, careful assessment, monitoring and treating related electrolyte disturbance is very essential to avoid serious complications of this syndrome.Regular monitoring of electrolytes, BUN, creatinine, uric acid, phosphates and calcium levels forms the basis of therapy. Patients should be well hydrated (200-300ml/hr). Urinary flow should be increased by diuretics such as Mannitol. Sodium bicarbonate 100mEq/l should be given for urinary alkalization, Allopurinol 500 mgm/m 2 on day 1 to day 3 then reduced to 200mgm/m2 throughout cytoreductive therapy.8 Calcium therapy and exchange resins for hyperkalemia may be considered. Calcitrol therapy may be considered for persistently low Calcium levels.9 SIADH SIADH, characterized by hyponatremia that occurs due to the production of arginine vasopressin by the tumour cells. Hyponatremia is related with plasma hyposmolarity and high urinary osmolarity, together with a high level of elimination of urinary sodium without any change in plasma volume. 6 Other reasons may include use of some drugs like ACE inhibitors, antidepressants, and antimitotics such as cyclophosphamide, vincristine, cisplatin, melphalan and even some surgical procedures and due to some tumours like small-cell lung cancer. 10Most of the patients are asymptomatic. Early symptoms include anorexia, irritability, depression, musc...

Does Customized Handle Toothbrush Influence Dental Plaque Removal in Children with Down Syndrome? A Randomized Controlled Trial

“…Accordingly, it is desirable to use toothbrushes with small head, which corresponds to the size of the children's mouth, with soft rounded bristles and with short handle and large diameter to fit the child's hand [12,13]. It is highly recommended to have a design and length that properly fit the child's hand to improve the quality of tooth brushing [14].…”

Analyzing of Urine 3-Hidroxy Propil Mercapturic Acid on Cyclophosphamide Induced Rat to Determine Ameliorating Effect of Leucaena leucocephala (Lam.) de Wit Seed Extract

“…6 Hemorrhagic cystitis occurs in 10% of patients receiving normal doses and 40% of patients receiving high doses of cyclophosphamide, despite precautions. 7,8 Acrolein is a metabolite of cyclophosphamide, and it was identified as being responsible for causing hemorrhagic cystitis. 1,2 The incidence of hemorrhagic cystitis can be reduced by stopping treatment or reducing the dose of the drug, and it can also be decreased by 6%-50% with bladder irrigation and mesna administration.…”