ABC of palliative care: Emergencies

The concept of rapid assessment, evaluation, and management of symptoms due to malignancy is generally accepted. Inherent in this concept is rapid reversal of what is reversible. Some acute events in malignancy have to be treated as an emergency if a favourable outcome is to be achieved. As in any emergency, the assessment must be as prompt and complete as possible. In patients with advanced malignancy, factors to consider include. While unnecessary hospital admission may cause distress for the patient and carers, missed emergency treatment of reversible symptomatology can be disastrous. #### Major emergencies in palliative care Other emergencies, such as haemorrhage and acute anxiety and depression, are discussed elsewhere in this series #### Questions to ask when considering management of emergencies in patients with advanced disease Hypercalcaemia is the commonest life threatening metabolic disorder encountered in patients with cancer. The incidence varies with the underlying malignancy, being most common in multiple myeloma and breast cancer (40-50%), less so in non-small cell lung cancer, and rare in small cell lung cancer and colorectal cancer. #### Presenting features of hypercalcaemia ##### Mild symptoms ##### Severe symptoms and signs It is important to remember non-malignant causes of hypercalcaemia—particularly primary hyperparathyroidism, which is prevalent in the general population. The pathology of hypercalcaemia is mediated by factors such as parathyroid related protein, prostaglandins, and local interaction by cytokines such as interleukin …