ICU · Haematology / oncology

Oncologic Emergencies — TLS, Hypercalcaemia, Hyperviscosity, SVC, Cord Compression, Neutropenic Sepsis & Checkpoint Toxicity

Also known as Oncologic emergency · Tumour lysis syndrome · TLS · Hypercalcaemia of malignancy · Superior vena cava syndrome · SVC syndrome · Malignant spinal cord compression · MSCC · Rasburicase · Allopurinol · Zoledronic acid · PTHrP · Hyperviscosity syndrome · Waldenström macroglobulinemia · Plasmapheresis · Neutropenic sepsis · Febrile neutropenia · Immune-related adverse event · irAE · Checkpoint inhibitor pneumonitis · Immune checkpoint inhibitor colitis · Cairo-Bishop classification · Cord compression · Denosumab

The oncologic emergencies in the ICU: (1) tumour lysis syndrome (TLS — cell lysis to hyperkalaemia, hyperphosphataemia, hypocalcaemia, hyperuricaemia, AKI; Cairo-Bishop classification; prophylaxis hydration plus allopurinol 300 mg/day or rasburicase 0.2 mg/kg; treat rasburicase plus RRT in severe cases), (2) hypercalcaemia of malignancy (PTHrP, osteolytic, ectopic vitamin D; treat IV saline plus zoledronic acid 4 mg, calcitonin bridge, denosumab 120 mg if refractory), (3) hyperviscosity syndrome (Waldenstrom IgM; urgent plasma exchange), (4) superior vena cava syndrome (facial and arm swelling; treat the tumour — RT, chemo, endovascular stent), (5) malignant spinal cord compression (back pain, weakness, sensory level; dexamethasone 16 mg daily (CEPO; avoid high loading doses) plus urgent whole-spine MRI; Patchell trial), (6) neutropenic sepsis (the 1-hour rule — empiric anti-pseudomonal beta-lactam within 1 hour of triage), and (7) immune-related adverse events from checkpoint inhibitors (colitis, pneumonitis, hepatitis, myocarditis — withhold ICI, corticosteroids, infliximab or vedolizumab for refractory colitis).

Checked against its sources on 2 Sept 2026