Metabolic Emergencies

 Cancer can cause endocrine and metabolic complications due to;

• the direct effect of the primary tumour or its metastases interfering with function by infiltration or obstruction

                              or

• by the release of products such as hormones,cytokines and growth factors by tumour cells or normal cells as a response to the presence of the tumour 

• Hypercalcaemia has been reported to occur in up to 30% of patients who have a malignancy. 

• Hypercalcaemia of malignancy -       UKONS initial management 

• Emergency management of acute hypercalcaemia in adult patients/ SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE

• Hypercalcaemia in malignancy - causes, pathophysiology, symptoms, treatment - YouTube

• Hypomagnesaemia is an electrolyte imbalance and is indicated by a low level of magnesium in the blood.  The normal adult value for magnesium is 1.5-2.5 mEq/L. Normal levels of magnesium are important for the maintenance of heart and nervous system function.

• Hypomagnesaemia - UKONS initial management 

• Hypomagnesemia in the Cancer Patient- Biruh T. Workeneh, Nupur N. Uppal, Kenar D. Jhaveri and Helbert Rondon-Berrios- Hypomagnesemia is a common medical problem that contributes to the morbidity and mortality of patients with cancer.

• Hyponatraemia (serum sodium <135 mmol/L) is common. Presentation can cover a broad spectrum of symptoms and signs. Severe hyponatraemia can be life threatening requiring emergency assessment and treatment.

• Hyponatraemia - UKONS initial management guideline 

• Emergency management of severe symptomatic hyponatraemia in adult patients: SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE

• Syndrome of inappropriate antidiuretic hormone secretion (SIADH); Rapid Learning Module  

• Acute hypocalcaemia can be life threatening, necessitating urgent treatment. In severe cases, intravenous calcium forms the mainstay of initial therapy, but it is essential to ascertain the underlying cause and commence specific therapy as early as possible

• Emergency management of acute hypocalcaemia in adult patients:SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE. 

• Tumour Lysis Syndrome - a potentially lethal metabolic complication 

• British Society for Haematology Guideline

• Tumour Lysis Syndrome (TLS) Rapid Learning Module.  

 Useful link -  The Society for Endocrinology