Topic: Fever and low blood pressure

At my husband's chemo visit Friday, we learned he had a very low grade fever and somewhat low blood pressure but the doctor didn't seem too concerned.  He was fine until last night when his fever was much worse.  When he had his pump disconnected today, his temperature was 101 and his blood pressure was 85/57.  After discussion with the doctor on call, the nurse sent him to the ER.  After numerous tests (even one for lactic acid), they could find no source of the fever or reason for the low blood pressure so they gave him some fluids and sent him home.  He seems to be feeling pretty well now and I plan to monitor his temparture and blood pressure carefully.  Does anyone have any thoughts on what might have caused this?  He is currently on FOLFORI.  By the way, today is our 28th anniversary and we had planned to go out to dinner tonight to celebrate.  However, we have certainly learned to be flexible and will celebrate next weekend instead.

Re: Fever and low blood pressure

Dear Linda, just wanted to wish you and Hubby a very Happy Anniversary. Teddy only had fevers and chills when he was getting an infection, which is quite common especially if stented. The ONC always said anything over 101 ....go to ER... He once had his BP drop to 54/44 and it was an e coli infection. AS IF these guys don't go through enough just with CC!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Fever and low blood pressure

Hi Linda,

Does your husband have a port a cath?  Did the ED draw blood cultures from his port, or peripherally? (from his skin)
How many chemo treatments did he have this week, last week, or was Friday the first one?
Did the hospital tell you what his white blood cell count or absolute neutrophil count was?
If Friday was his first treatment of the week, then it is too early for your husband to have had the typical "nadir", or when the blood counts show a  decrease.  This is usually 7-14 days after chemotherapy.

The Oncologist and the oncology nurses will not start chemo unless the counts are sufficient enough to begin. 

Does he have a sore throat or been around anyone that could have been sick?
If he has a  port, how new or old is it? Any problems with it? (are the nurses able to flush it and draw blood without difficulty? )
If he spikes a temp again over 100.5, becomes dizzy/lightheaded, has diarrhea from the Irinotecan, not managed with the oral meds, etc. ,  I would call the on-call doctor again, or bring him to the ER.  Being that he has a slight temp and low blood pressure  BEFORE the chemo, makes me think that something (an infection) might be brewing but I am just speculating and don't know the whole picture.

I will try to help if I can!


-Karen  (oncology nurse)


"Just advise based on experience, but please consult your doctor too".

Re: Fever and low blood pressure

Oh, and I'm sorry to bombard you with questions on your anniversary!!!

I hope that you are able to have an enjoyable night together. smile

Karen

Re: Fever and low blood pressure

Thank you for the anniversary wishes, Lainey!
Karen, thank you for your reply and I'll do my best to answer your questions.  He has intrahepatic CC and does not have a stent.  He got the port in early November and has had no problems with it.  He doesn't have a sore throat or any other symptoms and we aren't aware of his having been around anyone who is ill but he does visit a number of offices in his job so that is a possibility.  He has chemo every other Friday and then wears a pump until Sunday morning.  On Friday his WBC count was 7.5 and his absolute neutrophil was 5.66. 
They took some blood from the port but they also drew it from two separate places on his arms.  Although the preliminary results were OK, they said that the final blood cultures will take 24 hours.  They also did a urine test that was negative.  Apparently they were concerned that the low blood pressure could be caused by lactic acid but that test was negative also.
At the moment his fever seems to be gone and he is feeling well but I'm concerned it may come back tonight as it did last night.  I'll keep an eye on him and will definitely call the on-call doctor if he has problems.

Re: Fever and low blood pressure

Hi Linda!

Looks like his counts are good! 

I would assume that he is receiving the 5FU (Flourouracil) via the CADD pump.  Usually people tolerate this fairly well, and I haven't generally seen low B/P occurring from it.
Dehydration could have been the cause for the low B/P initially, and could also cause the temperature increase,........If he has been having diarrhea or poor fluid intake this could be a factor. (The Irinotecan which he probably got on Friday, will do that).

It is funny, and I see it all the time, people tend to spike those temps at night.  I often will check temps every 4 hours on someone such as your husband, and give Tylenol if ordered before the temp goes above 99.0. Any other weird symptoms that he feels or you are seeing?

I'm sorry that this is causing so much worry for you both.  I hope he isn't feeling too poorly, and you are doing all of the right things for him.

-Karen

Re: Fever and low blood pressure

Thanks Karen.  Yes, you are correct about the Ironotecan and 5FU.  He did have some diarrhea problems (resulting in some dehydration) for a while but the doctor reduced the dose a bit at one point so it really hasn't been a problem during the past couple of months.  One thing the ER doctor did today is eliminate one of the two drugs he was taking for prostate problems.  Apparently it can cause low blood pressure.  The fever really is a mystery to me  but, overall, he has been tolerating chemo quite well.  He tries to get a lot of rest but he still works full-time and we have a pretty good life most of the time. My husband tends to be very positive and optimistic and that really helps.

Re: Fever and low blood pressure

Linda,
There is also something called tumor fever.
Here is a way too detailed link, but I am fairly certain that it has been discussed on the board here at one time or another. I will look around and see if I can find the old posts for you.


http://www.cancer.gov/cancertopics/pdq/ … ient/page2

Re: Fever and low blood pressure

http://www.cholangiocarcinoma.org/punbb … hp?id=9663

Re: Fever and low blood pressure

Karen....thanks for all you do.  Yes, we do have numerous postings on tumor fever. 
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

11 (edited by KarenD Sun, 09 Jun 2013 21:07:54)

Re: Fever and low blood pressure

Hello Marion!

I did find one of your old posts about tumor fever. I do see it quite often and Tylenol generally does the trick!

Thank you for your kind words too. We are all in this together, and I am glad to help out in any way.

Karen

Re: Fever and low blood pressure

Found this tonight -

http://www.cancerresearchuk.org/cancer- … cer-itself

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.