Question regarding MAA case

[davidjones]

So had a patient recently with diffuse metastatic liver disease (colon CA as primary) came in for mapping and shunt study with MAA prior to y90 therapy. Procedure went off just fine, zero complications, ended up keeping patient overnight because they lived far away, didn't have a ride, and got sedation. On PM rounds, patient developed fever of 38.5, WCC of 19.1 (baseline was between 13-15) and just general malaise and HA. UA, CXR were fine (minus minimal atelectasis, but lots of literature shows is not a cause of fever). Blood cultures/urine ctx sent but still pending.Too early for her to get DVT and she'd been ambulatory following the 6 hour bed rest. Medicine was consulted, they couldn't think of anything either, so pt dc'd and told to f/up with PCP in 3-5 days or go to ER if spikes fever.

Questions: Anyone ever here of post-MAA injection fever, we really did not do anything else the whole thing took less than an hour. Our initial, and persistent thought is this is a paraneoplastic thing as her tumor burden is very high.

Would anyone manage her differently?


An unrelated question: how do you guys manage your post-chemoembo patients' pain? We do IV dilaudid 0.5mg q2hrs, if that doesn't work, switch to PCA. Are there SIR/ACR recommendations?

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[Gvataken]

Interesting. Why did the patient have a baseline leukocytosis pre injection? I would have probably done the same and called the patient to see if they were feeling better.

As far as post TACE orders.

I usually give them tramadol for mild pain, morphine 2 mg q 4 hours prn moderate pain.

zofran 4 mg q 6 for nausea

ambien for sleep

pepcid or prilosec

scds

 

[IRGuru]

What ended up happening with the patient? Anything unexpected?

 

[davidjones]

she ended up doing fine, we attributed it to paraneoplastic syndrome and we just did her y90 today.