Management of Oncologic Emergencies: Steroids for Brain Metastases and Hypercalcemia

The initial step for brain metastases involves administering steroids such as dexamethasone, especially in cases of symptomatic metastases. Prophylaxis with antiepileptics is unnecessary unless seizures have occurred. High-dose steroid recipients require prophylaxis for insulin sliding scale, peptic ulcer disease, PJP, and bone protection. Single brain metastases can be treated with surgery or stereotactic radiosurgery, while multiple metastases may warrant whole-brain radiation. In some cases, systemic therapy with blood-brain barrier penetration might be preferred. For hypercalcemia, grading severity is crucial, with fluid resuscitation, bisphosphonates, and steroids being key management strategies. Severe hypercalcemia requires rapid volume expansion and maintenance of urine output. Steroids are indicated for hypercalcemia due to multiple myeloma or lymphoma, but not typically for solid tumors.