Pediatric emergency medicine trisk 2741 2741
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known or not) when starting antibiotics and other medications that are renally
excreted.
GENITOURINARY COMPLICATIONS OF CANCER TREATMENT
The most common form of bladder injury in cancer patients is hemorrhagic cystitis,
a potential complication of exposure to cyclophosphamide or ifosfamide. Prevention
of drug-induced hematuria usually includes hydration, frequent voiding, and
administration of mesna (2-mercaptoethane sulfonate sodium), a drug that binds the
toxic metabolite. Manifestations include dysuria, suprapubic pain, and microscopic
or gross hematuria with onset within 24 hours of drug administration. Other causes
of toxicity to the GU tract include infection, bladder radiation, tumor resection, or
ongoing presence of tumor in the GU tract.
If a patient is complaining of bladder-related symptoms or the urinalysis shows
evidence of hematuria, the oncology-specific history should be reviewed to help
develop an appropriate differential diagnosis in addition to the usual causes (such as
infection) that would be considered in a patient without cancer. Initial management
should include initiation of one and one-half times to twice maintenance hydration
and frequent voiding. Laboratory evaluation should include a urinalysis, CBC to
look for anemia or thrombocytopenia, and coagulation studies. Any contribution
from coagulopathy and/or thrombocytopenia should be corrected. If severe bleeding
or bladder outlet obstruction from clots occurs, a urologist should be consulted. A
bladder catheter large enough to be used for irrigation should be placed and bladder
washing initiated. Packed red blood cell transfusion may be needed. In very rare
cases, bleeding can be life threatening and bladder sclerosis is indicated. Mesna has
no utility once the offending drug has cleared from the system. Pain management
with oxybutynin chloride and narcotics should be initiated as needed.
SKIN COMPLICATIONS OF CANCER TREATMENT
Various cancer treatments are known to have cutaneous toxicities. Radiation induces
dermatitis in the treatment field that can range from mild to severe based on the total
dose and any concurrent radiation sensitizers. The presentation may vary from a
mild erythroderma, similar to sunburn, to severe desquamation in the treatment
field. Any topical treatment must be prescribed in conjunction with the treating
radiation oncologist because certain topical agents may increase the radiation dose
to the skin.
Drug rashes are very common in oncology patients. Because patients tend to be
on many drugs at one time, it may be difficult to identify the specific culprit.
Management of a drug reaction is not unique in oncology patients. However,
consultation with the oncologist may be needed to discuss if alternate treatment is
needed.
