Side effects of systemic cancer therapy - diarrhoea
Red flags
- *Fever + neutropenia + diarrhoea = neutropenic sepsis until proven otherwise* - blood cultures and antibiotics within 60 minutes
- Neutropenic enterocolitis (typhilitis) - RIF pain, fever, neutropenia, bowel wall thickening on CT; high mortality, surgical review
- Bloody diarrhoea, tenesmus, mucus -> immune colitis, C. difficile, CMV, ischaemia
- Abdominal distension, peritonism, absent bowel sounds -> toxic megacolon or perforation
- Grade 3-4 (>=7 stools/day above baseline, or any needing hospitalisation) -> admit
- Postural hypotension, AKI, hypokalaemia, metabolic acidosis -> severe volume loss
- Diarrhoea + severe mucositis + cytopenias after 5-FU/capecitabine -> *suspect DPYD deficiency - potentially fatal*
- Diarrhoea on a checkpoint inhibitor at any grade -> low threshold to investigate and treat as immune colitis
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