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