194 T. Kühne

18.2.3 Treatment

• Patients must be counseled to contact medical help in case of fever and neutropenia to check ANC

• Emergency hospitalization

• Empirical broad-spectrum intravenous antimicrobial therapy

18.2.4 Outlook

• Risk-adapted antimicrobial treatment approaches

18.3 Hyperkalemia

18.3.1 General

•Often caused by tumor lysis (transcellular shift of potassium from the intracellular to extracellular fluids; see above). Other causes include diminished renal excretion, impaired renal function, high potassium intake (dietary, iatrogenic, transfusion of old packed red cells), hemolysis, drugs, e.g., digitalis overdose, potassium-sparing diuretics (spironolactone). Collaboration with nephrology and intensive care departments recommended

18.3.2 Diagnosis

•Symptoms: neuromuscular effects: paresthesia, weakness, ascending paralysis. Cardiac effects: alterations in cardiac excitability resulting in dysrhythmias and potentially ventricular fibrillation and cardiac arrest

•ECG: peaked T waves (early manifestation), prolongation of PR interval, loss of P waves, widening of the QRS complex, ventricular fibrillation, cardiac arrest

•Laboratory analysis: CBC (rule out hemolysis), sodium, potassium (normal value 3.5–5.5 mmol/l), urea, creatinine, LDH, Ca, Phosphor, other investigations according to origins of the hyperkalemia

18.3.3 Treatment

•No potassium

•Treatment indication when potassium is more than 6.5 mmol/l:often there are “house rules”

•Alkalinization with NaHCO3 2 mmol/kg/10–15 min

•Calcium gluconate 10% 0.5–1 ml/kg over 10 min, with ECG monitoring and/or 0.5–1.0 g glucose/kg and 0.3 U insulin/g glucose over 30 min i.v. (hypoglycemia is a possible complication)