Chemotherapy Emergencies

Question 1

Neutropaenic Sepsis

Answer 1

Chemotherapy induced bone marrow suppression

Question 2

Chemotherapy Hypersensitivity

Answer 2

Essentially anaphylaxis
Recognise: fever, hypotension, tachycardia, low oxygen sats, wheeze, oro-pharyngeal oedema

STOP INFUSION!!

Oxygen, IV fluid, antihistamine (10mg chlorpheniramine stat), IV hydrocortisone 200ml,
adrenaline 0.5ml of 1:1000 IM, consider salbutamol / adrenaline nebuliser

Question 3

Tumour Lysis Syndrome

Answer 3

Rapid tumour cell kill by effective therapy releases intracellular contents into the extra cellular compartment (urate, potassium, phosphate….)

Prevention better than treatment (allopurinol)
IV - high risk patients
Oral - low risk patients

Question 4

TLS

Answer 4

Leads to high K and phosphate in the presence of low calcium.

Should be considered in anyone presenting with AKI in the presence of high phosphate and high uric acid levels.