Sarah Klemencic, MD; Jack Perkins, MD


Western J Emerg Med. 2019;20(2):316-322. 

In This Article


Oncologic emergencies are becoming increasingly common presentations in the ED both in the community and academic settings. Emergency providers must appreciate the complexity of NF and understand that early, broad-spectrum antibiotics are key to reducing mortality even if the patient does not ultimately get admitted. Tumor lysis syndrome is a subtle but lethal metabolic derangement seen most often in hematologic malignancies that requires aggressive fluid resuscitation and electrolyte management. Hypercalcemia of malignancy heralds a poor prognosis and goals of care should be addressed while providing IV volume resuscitation to counter the osmotic diuresis caused by the hypercalcemia. Finally, hyperviscosity syndrome is especially dangerous as it mimics more common presentations but should be in the differential for any patient with WM, multiple myeloma, severe leukocytosis (i.e., >100 x 104), or a hemoglobin > 20 g/dl. All of these oncologic emergencies require early involvement of oncology for management.