Post Conference Letter, 4/22/09
Thanks to Dr. Close for her wonderful M+M presentation yesterday. The following M+M tips are adapted from Dr. Strayer’s followup email:
We recently saw a patient with active malignancy present with typical symptoms of hypercalcemia. Though the GEMM was resulted shortly after presentation and demonstrated a very high ionized calcium (more than twice the upper limit of normal and qualifies as hypercalcemic crisis), the diagnosis was not made for some time.
Consider the following diagnoses in patients with malignancies who present with unexplained symptoms.
1. Malignant pericardial effusion. Have a low threshold to perform point-of-care ultrasound to evaluate for an effusion.
2. Spinal cord compression. Back pain, lower extremity weakness, urinary retention, fecal incontinence.
3. Hypercalemia. Lethargy, confusion, generalized weakness.
4. Tumor lysis syndrome. Hematologic malignancy s/p chemotherapy with renal failure and electrolyte disturbances.
5. Neutropenic fever. Definition is a single temperature ? 101 (38.3) or fever of 100.4 (38.0) lasting longer than 1 hour in patient with ANC < 500. ANC = WBC * (%PMNs + %bands).
6. SVC syndrome. Dyspnea, hoarseness, cough, facial and upper extremity swelling with distended neck and chest wall veins, facial edema and plethora.
7. Intracranial metastases. Seizure, altered mentation, neurologic symptoms or signs.
8. Hyperviscosity syndrome. Multiple myeloma / Waldenstrom’s / Leukemia blast crisis / Polycythemia patient with visual changes, mental status changes or neurologic symptoms, bleeding diathesis, or CHF.
Posted
on Wednesday, April 22nd, 2009 at 11:28 pm by Nick. Filed under
Post-Conference Letter, Oncology, Blog.
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