Info
🌱 來自: Huppert’s Notes
Metabolic Emergencies🚧 施工中
Metabolic Emergencies
Hypercalcemia of malignancy
• Pathophysiology: Multiple possible mechanisms
- Tumor secretion of PTHrP (most common) – often SCC of lung, breast cancer, RCC
- Osteolytic metastases, which cause increased bone turnover – commonly MM, breast cancer
- Tumor production of 1,25-OH Vit D – Hodgkin’s and NH lymphoma
• Symptoms: “Stones, groans, moans, psychiatric overtones” – kidney stones, nausea, vomiting, abdominal pain, bony pain, AMS
• Diagnosis: ↑Ca2+ level (corrected for albumin), dehydration (↑Cr, ↑Na+)
• Treatment:
- Aggressive hydration (200–300 mL/hr to maintain UOP of 100–150 ml/hr). Caution in heart failure and volume overload. Generally only use diuretics if there is concern for iatrogenic hypervolemia. Effect seen: Hours.
- Calcitonin 4IU/kg Q6–12 hrs for up to 48 hrs (patients will develop tachyphylaxis after 48 hrs of therapy). Effect seen: Hours to days.
- Bisphosphonate: Usually zoledronic acid. One-time dose, so full dose ok in renal dysfunction and no dental evaluation needed prior to treatment. Effect seen: 2–4 days.
- Denosumab: Monoclonal antibody to RANK-ligand → blocks activation of osteoclasts, which promote bone breakdown and Ca2+ release. Generally, bisphosphonates are preferred over denosumab for acute treatment of hypercalcemia of malignancy. Effect seen: 4–10 days.
Neutropenic fever
• See details in the hematology section under oncologic emergencies
DIC and TLS
• Less common with solid than hematologic malignancies but can occur with solid tumor malignancies
• See details in the hematology section under oncologic emergencies