Pediatric emergency medicine trisk 2728 2728
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tumor itself. This complication is more common if patients are also taking calcium
supplements or calcium-containing medications such as antacids. If asymptomatic,
hypercalcemia does not always require intervention. When present, symptoms may
include nausea/vomiting, constipation, altered mental status, and renal failure.
Management in these cases is similar to strategies to address hypercalcemia outside
of the oncology setting (see Chapters 89 Endocrine Emergencies and 100 Renal and
Electrolyte Emergencies ). However, steroids should be avoided in patients with
known or suspected leukemia or lymphoma. Control of the underlying malignancy
is the best way to address the hypercalcemia.
SIADH can develop as a result of some cancers themselves, particularly those
involving the lungs or CNS, or from treatment with vincristine and
cyclophosphamide. Management of this complication hinges on fluid restriction and
does not differ from that of SIADH developing in other settings (see Chapter 100
Renal and Electrolyte Emergencies ).
PAIN
Goals of Treatment
Pain is a true emergency. The relief of pain is a critical element of caring for
children with cancer, and should be addressed even in patients who present to the
ED for other concerns.
CLINICAL PEARLS AND PITFALLS
NSAIDs and aspirin are generally avoided due to their antiplatelet activity.
Cancer patients are frequently not opioid naïve and may require higher
starting doses than are standard.
Current Evidence
Unfortunately, pain is a common symptom in oncology patients with data showing
that more than 30% of pediatric cancer patients have experienced pain in the
previous week. When pain leads to visits to the ED, it requires careful and
immediate management. Severe pain is a true emergency in and of itself, and also
may be particularly upsetting for cancer patients who may have already confronted
significant pain as part of their cancer diagnosis, who may anticipate or fear future
pain, and who may worry (usually needlessly) that their pain is a sign of progressive
cancer.
In some cases, pain may be related to the tumor itself and therefore often will
respond to chemotherapy or other cancer-directed therapies. Tumors can cause
