10 Questions
What is the primary purpose of administering a bisphosphonate in the management of oncologic emergencies?
To reduce the risk of hyperphosphatemia
What is the primary indication for hemodialysis in patients with tumor lysis syndrome?
Severe electrolyte abnormalities
What is the mortality rate for neutropenic sepsis if not treated within the first 48 hours?
50%
What is the recommended antibiotic therapy for neutropenic fever?
Ceftazidime 2 g IV
What is the definition of febrile neutropenia?
Fever >38°C with an absolute neutrophil count of 15 mg/dL
What is the primary goal of IV hydration in the management of tumor lysis syndrome?
To reduce the risk of acute kidney injury
What is the recommended management for patients with hyperkalemia due to tumor lysis syndrome?
Perform hemodialysis to remove excess potassium
What is the maximum effect of bisphosphonates in the management of hyperphosphatemia?
Within 2-4 days
What is the primary indication for the addition of vancomycin to antibiotic therapy in neutropenic fever?
All of the above
What is the recommended initial management of febrile neutropenia?
Administer empiric antibiotic therapy and IV hydration
Study Notes
Febrile Neutropenia
- Defined as a fever >38°C with an absolute neutrophil count of <500/μL (or <1500/μL with a predicted decline to <500/μL)
- Characterized by hyperphosphatemia (>8 mg/dL), hyperkalemia, and hypocalcemia
- A complete blood count (CBC) should be obtained on all patients to assess for neutropenia
- ANC <500/μL requires treatment, and ANC <100/μL is considered severe neutropenia
Treatment of Febrile Neutropenia
- Initial bolus of 1-2 L of normal saline (NS)
- Loop diuretics (40-80 mg furosemide IV)
- Bisphosphonates may also be used, but their maximum effect does not occur for 2-4 days
- Hemodialysis may be indicated in severe cases
- Empiric antibiotic therapy should be administered promptly, with ceftazidime 2 g IV and vancomycin added for patients with sepsis, known methicillin-resistant Staphylococcus aureus, or indwelling venous catheters
- If not treated in the first 48 hours, mortality for neutropenic sepsis approaches 50%; prompt administration of empiric antibiotic therapy reduces mortality to 10%
Tumor Lysis Syndrome (TLS)
- Characterized by hyperkalemia, hyperphosphatemia, and hypocalcemia
- Treatment includes:
- IV hydration (NS)
- Loop diuretics
- Allopurinol
- Hyperkalemia remains the most dangerous component of TLS due to life-threatening dysrhythmias
- Hemodialysis may be needed in patients with renal failure, severe electrolyte abnormalities, or fluid overload
MASCC Criteria for Neutropenia
- Used to assess the severity of neutropenia
- Criteria include:
- Age
- Burden of illness
- Presence of medical comorbidities
- Dehydration
- Hypotension
- Invasive lines or catheters
- Pneumonia
Outpatient Management of Febrile Neutropenia
- Eligibility criteria include:
- Mild symptoms
- No dehydration or hypotension
- No medical comorbidities
- No pneumonia or sepsis
- ANC >100/μL
Triage and Assessment of Oncologic Emergencies
- Use the CTAS (Canadian Triage and Acuity Scale) and ESI (Emergency Severity Index) to triage oncologic emergencies
- Calculate the ANC for patients with neutropenia
- Identify common ECG changes associated with electrolyte imbalances among patients with oncologic emergencies
This quiz covers febrile neutropenia, a hematologic emergency, its definition, symptoms and treatment. Learn about the laboratory tests required to diagnose and manage this condition.
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