METABOLIC DISORDRES

IN EMERGENCY ONCOLOGY
KIKI A. RIZKI
SURGICAL ONCOLOGY DIVISION
DEPARTEMENT OF SURGERY
HASAN SADIKIN HOSPITAL BANDUNG
INTRODUCTION
• Oncologic emergencies are common in emergency medicine (EM).
However, they may not often present to emergency departments (ED)
that do not serve a robust oncology population.

• contributing to increased morbidity and mortality.

Klemencic et al, Western Journal of Emergency Medicine , Volume 20, no. 2: March 2019
TUMOR LYSIS SYNDROME
• Tumor lysis syndrome (TLS) is a rare but potentially deadly metabolic
crisis with an estimated mortality of 29-79%.

• Tumor lysis syndrome occurs due to the liberation of intracellular

components into the circulation.

• While TLS most commonly occurs subsequent to chemotherapy, it

may occur spontaneously in patients with hematologic malignancies
(especially acute leukemias)
• The predominant intracellular contents released systemically include
potassium, phosphate, and uric acid  laboratory values may reflect
hyperkalemia, hyperphosphatemia, hypocalcemia, and
hyperuricemia.

• Presenting symptoms can include fatigue, signs of dehydration,

seizures, cardiac dysrhythmia, nausea and vomiting.
PATHOGENESIS CLINICAL MANIFESTATION
Wagner & Arora, Emerg Med Clin N Am 32 (2014) 509–525
PATHOGENESIS HYPERURICEMIA
RISK ASSESMENT TLS
MANAGEMENT TLS
Wagner & Arora, Emerg Med Clin N Am 32 (2014) 509–525
MANAGEMENT HYPONATREMI
HYPERCALCEMIA
LACTITC ACIDOSIS
HYPERCALCEMIA OF MALIGNANCY
• It is defined as a total serum calcium concentration greater than 10 mg/dL
or an ionized calcium concentration greater than 5.6 mg/dL.

• Hypercalcemia is the most common oncologic metabolic emergency, with

an incidence of 10% to 30% at some point during disease course.

• It is further classified as
- mild (10–12 mg/dL; 5.6–8 mg/dL ionized),
- moderate (12.1–14 mg/dL; 8.1–10 mg/dL ionized),
- severe / crisis (>14 mg/ dL; >10 mg/dL ionized)
PATHOGENESIS
CLINICAL MANIFESTATION
MANAGEMENT
• Hydration

• Loop diuretic

• Pharmacologic therapy :
- bisphosphonate
- glucocorticoid (prednisone) : MM, lymphoma
• Hemodyalisis : severe refracter hypercalcemia, renal failure
TERIMA KASIH
REFERENCE
• Stacey Stein and Hari A Deshpande, Matabolic Emergency in Cancer Principle and
Parctise of Oncology 11th Edition, De Vita, Hellman and Rosenberg’s editor, 2019

• Thorvardur R. Halfdanarson, MD; William J. Hogan, MBBCh; and Bo E. Madsen,

MD, MPH , Emergencies in Hematology Oncology, Mayo Clin Proc. n April
2017;92(4):609-641

• Jonathan Wagner, Sanjay Arora, Oncologic Metabolic Emergencies, Emerg Med

Clin N Am 32 (2014) 509–525

• Klemencic et al, Western Journal of Emergency Medicine , Volume 20, no. 2:

March 2019