Page 214 - Critical Care Notes

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HEMA/
ONCO

Malignant Spinal Cord Compression
Compression of the spinal cord is caused by a tumor that directly enters the
spinal cord or by vertebrae collapsing in response to deterioration of the bone
secondary to a tumor. The compression site can be from a primary tumor, but
compression usually results from metastases from the lung, prostate, breast,
colon, thoracic spine, or pelvic lumbosacral spine.
Clinical Presentation
■ Back pain
■ Numbness
■ Tingling
■ Loss of urethral, vaginal, and rectal sensation
■ Muscle weakness (neurological deficits are later signs)
■ Paralysis (usually permanent)
Diagnostic Tests
■ CT scan of torso
■ MRI of spine
Management
■ Provide early recognition and treatment.
■ Perform comprehensive neurological examination.
■ Administer high-dose corticosteroids to reduce swelling and relieve
symptoms.
■ Administer high-dose radiation to reduce tumor size and relieve symptoms.
■ Be aware surgery may be indicated to remove the tumor.
■ Apply external neck or back braces.
Malignant Hypercalcemia
Cancer in the bone → bone releasing Ca 2 + into bloodstream →↑ serum Ca 2 + lev-
els. Cancer in other parts of the body (especially squamous cell tumors of the
lung, head and neck, kidney, breast, or lymph nodes) → secretion of parathyroid
hormone by the tumor → release of Ca 2 + by the bone →↑ serum Ca 2 + levels.
Decreased mobility and dehydration worsen hypercalcemia. Hypercalcemic cri-
sis is usually defined as serum Ca 2 + >14 mg/dL (8.7–10.4 mg/dL normal) with
acute signs and symptoms.
Clinical Presentation
The mnemonic associated with this diagnosis: “Bones, stones, moans, and
groans”
■ Fatigue
■ Loss of appetite
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