0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

SIGNS/SYMPTOMS

■ Fatigue, lethargy, nausea, vomiting, cloudy urine, muscle spasm, altered

mental status

■ Acute renal failure, ventricular dysrrhythmias

DIAGNOSIS

■ Hyperuricemia

■ Hyperkalemia

■ Hyperphosphatemia

■ Hypocalcemia

TREATMENT

■ Hyperkalemia: Treat in standard fashion.

■ Hyperuricemia: Treat with alkalinization of the urine to maintain urine

pH 7.1–7.5.

■ Hemodialysis with refractory hyperkalemia >6 mEq/L or hyperuricemia

>10 mg/dL, phosphate levels >10 mg/dL, creatinine >10 mg/dL, sympto-

matic hypocalcemia or volume overload.

DERMATOLOGIC MANIFESTATIONS OF MALIGNANCY

The skin may show signs of internal disease. The following are skin disorders

associated with internal malignancy:

Ancanthosis Nigricans

■ Hyperpigmentation and hyperkeratosis of skin folds (axilla, antecubital

fossa, neck, and groin)

■ Associated with GI malignancies (adenocarcinoma), lung and breast CA;

also seen in patients with DM

Dermatomyositis

■ Systemic disease characterized by

■ Violaceous rash of eyelids and periorbital region

■ Erythema of face, neck, and upper trunk

■ Progressive proximal muscle weakness

■ Associated with breast, ovarian, uterine, stomach, colon, and lung CAs.

Erythema Multiforme

■ Erythematous plaques with pale centers and bright red borders distributed

in a symmetric fashion on extremities and oral mucosa

■ Associated with leukemias and Hodgkin disease, although herpes simplex

andM. pneumoniaeinfections are more common causes

Erythema Nodosum

■ Painful, erythematous nodules on extensor surfaces of lower extremities

■ Associated with leukemia, Hodgkin disease, and metastatic carcinoma,

though streptococcal infections and sarcoidosis are more common causes

Erythroderma

■ Diffuse erythema of the skin

■ Associated with Hodgkin disease, leukemia, and mycosis fungoides

To make a bicarbonate drip,

add three ampules of

bicarbonate to D5W.