Chemotherapy induced nausea and vomiting is one of the most common acute and distressing side effect of cancer treatment. It can result in serious fluid and electrolytede rangement.

CLASSIFICATION

• Acute; within the first 24hrs after chemotherapy
• Delayed; occurs more than 24hrs
• Anticipatory; occurs before a new cycle of chemotherapy in response to conditioned stimuli such as the smell, site or sound of treatment room. This usually occurs at V3-4 cycles.
• Chronic; in patients with advanced cancer. The cause is not well known but can be due to gastrointestinal, cranial, metabolic, drug induced e.g. morphine, cytotoxic chemo induced or radiation induced.

• Centrally acting antiemetics e.g. ondansetron @0.15mg/kg/dose IV 30 mins before chemo may be repeated 4-8hrly

• Corticosteroids- dexamethason

• Antiemetics.

• Correction of fluid and electrolyte imbalances.

It is one of the most catastrophic potential side effects of biologic and chemotherapy. May occur in oncology patients who are exposed to bacterial products such as L-asparaginase, or cytotoxic agents e.g paclitaxel. Any drug can lead to hyperimmune response resulting in anaphylaxis.

Angioedema and urticaria are the most common manifestations of anaphylaxis and make up >90% of allergic reactions to drugs.

Abdominal pain, chest tightness, upper airway obstruction, bronchospasm and hypotension. Laryngeal edema followed by hypotension is the most frequent cause of death related to allergic reactions.

• Use of ABC in resuscitation.
• Withdraw the offending drug

• Epinephrine
• Steroids
• Anti histamine

1. General Health Promotion: Use health education
2. Specific Protection
   1. Use of Allopurinol/ Rasburicase at diagnosis
   2. Hyperhydration prior to commencement of Chemotherapy
   3. Optimize haematological parameters before therapy
3. Early diagnosis and prompt treatment
4. Limitation of disability

• RRT

1. Rehabilitation

• Lack of basic supportive care
• Lack of blood products
• Lack of supportive care eg limited Icu spaces
• Lack of proper nursing care
• Lack of isolation wards to ensure reverse isolation
• Lack of trained man power in oncology care
• Need to establish a standard oncology unit with all required subspecialities
• Poverty – delay in presentation, poor nutrition
• Iilliteracy – poor health seeking attitude

Emergencies may arise at diagnosis, as a consequence of therapy, or at time of progression. It is important to anticipate and have high index of suspicion for oncologic emergencies. Careful history and physical examination. Prompt intervention can prevent long term complications. Management can and has improved survival of children with malignancies.