Multiple Myeloma

Multiple Myeloma is a malignant tumor of plasma cell. Plasma cell produce poly-clonal immunoglobulin. But plasma cell tumor is monoclonal. In Multiple Myeloma they can produce pure immunoglobulin or only heavy chain or only light chain.

Clinical Feature:
Diagnosis of MM requires two of the following criteria

1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary paraprotein
3. Skeletal lytic lesions.

Other features and investigation of MM:

• Generalized bony pain
• Recurrent infection
• Severe anemia with features of anemia
• Hypercalcemia
• Pathological calcification
• Features of hypercalcemia
• Retinal bleeds
• Bruising
• Heart failure
• Cerebral ischaemia
• Pancytipenia
• Raised ESR.

Plasma alkaline phosphatase and isotope bone scan will be normal despite the lytic action because there is no osteoblastic activity.

Management:

1. If patients are asymptomatic treatment may not be required.
2. Immediate support

• High fluid intake to treat renal impairement
• Analgesia for bone pain
• Biphosphonates for hypercalcaemia and to delay other skeletal related events
• Allopurinol to prevent urate nephropathy
• Plasmapheresis for hyperviscosity

1. Chemotherapy: Thalidomide
2. Bone marrow transplantation

Adverse effect of Thalidomide: Somnolence, Constipation, Peripheral neuropathy, Teratogenic effect.

Prognosis:
Low prognostic features include 

• High Microglobulin
• Low albumin
• Low Haemoglobin
• High calcium;  at presentation.

Median life expectancy: 2 Years.

• Absence of monoclonal band in plasma electrophoresis exclude MM.
• Amyloidosis is Only light chain producer.
• Another cause of very high ESR is Temporal arteritis.

          

Hydrocarbon Poisoning

Hydrocarbon includes:
Petrol, Kerosene, Lighter Fluid, Mineral turpentine, Paraffin Oil, Lubricating oil, Furniture Polishes, 2 stroke fuel, Diesel, White spirit.

Assessment:
1. Main complication is aspiration pneumonitis.
2. CNS toxicity can be evident, either by depressor or excitement.

Symptoms:
Coughing, Choking, respiratory distress, ataxia, drowsiness, coma, convulsions, persistent burping. 

Management:

1. Stabilizing the airway.
2. O2 inhalation
3. Early intubation, mechanical ventilation in patient in whom oxygenation is adequate or in patient who has severe respiratory distress or a decreased level of consciousness.
4. Precaution to minimize risk of vomiting and further aspiration.
5. Decontamination by removing involved clothing and thoroughly washing skin with soap water.
6. Gastric lavage is not indicated.
7. No antidote is available for hydrocarbon.
8. Steroids may be harmful
9. If there is aspiration pneumonitis -- than treatment is accordingly:
       Inj. Clindamycin or Inj Amoxicillin + Inj. Metronidazole.