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The most common oncology emergencies are febrile neutropenia (FN), TLS, malignant hypercalcemia, spinal cord compression, SVC syndrome, and brain metastases with increased intracranial pressure (Table 22-14).
|Neutropenic fever||Infectious||Temperature >38.3°C or >38°C two times 1 h apart|
|Tumor lysis syndrome (TLS)||Massive lysis of cancer cells (mostly with chemotherapy)||Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, AKI, cardiac arrhythmias, and/or seizures|
|Hypercalcemia||Humoral, PTHrP, bone metastasis, calcitriol mediated (lymphomas)||Dehydration, CNS symptoms, constipation, ileus, weakness, cardiac (bradycardia, short QT, prolonged PR, etc.)|
|Spinal cord compression (SCC)||Metastatic or involvement of spine in SCC||Pain, weakness, sensory loss, incontinence, ataxia|
|Superior vena cava (SVC) syndrome||Obstruction of SVC by primary or metastatic cancer (mostly intrathoracic)||Dyspnea, stridor (laryngeal edema), facial and upper extremity swelling, risk of cerebral edema and herniation|
|Hyperleukocytosis with leukostasis||Intravascular accumulation of blasts, with or without DIC||Chest pain, respiratory distress, stupor, TLS, DIC|
AKI, acute kidney injury; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia; CML, chronic myeloid leukemia; CNS, central nervous system; DIC, disseminated intravascular coagulation; NSCLC, non–small-cell lung cancer; PTHrP, parathyroid hormone-related protein; RT, radiotherapy; SCLC, small-cell lung cancer.