Wednesday, August 30, 2017

MM Emergencies

emDocs - August 29, 2017 - Authors: Xiao J and Todd B
Edited by: Koyfman A and Long B
"Takeaway points
  • Multiple myeloma is difficult to diagnose. Elderly patients with unremitting back pain or pathologic fractures of the axial skeletonshould be considered for multiple myeloma evaluation. Emergency department X-rays may clinch the diagnosis with punched out lytic bone lesions.
  • Cord compression is the most important emergency diagnosis. The absence of neurologic symptoms does not preclude cord compression.
  • The two most common causes of death in multiple myeloma patients are frequent infections, usually respiratory, and renal failure. Their disease process and medications make them immunocompromised.
  • Renal failure in multiple myeloma patients is multifactorial and has a poor prognosis. Treat acute kidney injury aggressively and contact oncology early.
  • Electrolyte abnormalities should be treated by managing the underlying disease process. Multiple myeloma patients are especially prone to hypercalcemia due to osteoclastic bone activity. Treat with generous fluid hydration, and consider loop diuretics (controversial), calcitonin, bisphosphonates in conjunction with their oncologist.
  • Multiple myeloma medications may cause venous thromboembolism and neuropathy."