{"id":468,"date":"2013-06-05T11:58:07","date_gmt":"2013-06-05T09:58:07","guid":{"rendered":"http:\/\/www.fmc-tourcoing.org\/new\/?p=468"},"modified":"2013-06-05T18:13:02","modified_gmt":"2013-06-05T16:13:02","slug":"les-effets-secondaires-de-la-chimiotherapie","status":"publish","type":"post","link":"https:\/\/www.fmc-tourcoing.org\/new\/2013\/06\/les-effets-secondaires-de-la-chimiotherapie\/","title":{"rendered":"Les effets secondaires de la chimioth\u00e9rapie"},"content":{"rendered":"

Les effets secondaires de la chimioth\u00e9rapie<\/b><\/p>\n

FMC Mardi 4 Juin 2013<\/b><\/p>\n

Article VO \u00e0 t\u00e9l\u00e9charger :\u00a0EffetsSecondairesChimioTTT<\/a><\/p>\n

T\u00e9l\u00e9charger le Diaporama :\u00a0effetsSecondairesChimioDiapoR<\/a><\/p>\n

Rem\u00e8des locaux suite Chimio :\u00a0RMD-Peau-ChimioTTT<\/a><\/p>\n

\u00a0<\/b><\/p>\n

Docteur Nathalie Leriche<\/p>\n

C H Dron<\/p>\n

Tel\u00a0: 03 20 69 44 88<\/p>\n

Fax\u00a0: 03 20 69 45 99<\/p>\n

 <\/p>\n

Effets secondaires Cardiovasculaires\u00a0:<\/h1>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 5 fluoro-uracile<\/h2>\n

Risque de spasme coronarien<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Avastin*<\/h2>\n

Risque HTA, Thromboses, H\u00e9morragies, (perforation digestive)<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Herceptin*<\/h2>\n

Risque d’insuffisance cardiaque<\/p>\n

Surveillance de la fraction d’\u00e9jection tous les 3 mois en cours de \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 traitement<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Thrombose veineuse et embolie pulmonaire<\/h2>\n

Chez les patients ayant un cancer, les AVK sont moins efficaces et moins bien tol\u00e9r\u00e9s<\/p>\n

Un traitement par HBPM est donc recommand\u00e9<\/p>\n

La dur\u00e9e du traitement est de 3 \u00e0 6 mois en fonction de l’\u00e9volution du cancer \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 et des traitements en cours<\/p>\n

Fragmine* est la seule HBPM ayant une indication valid\u00e9e par son AMM chez les patients ayant un cancer (Innohep* en attente d’AMM)<\/p>\n

 <\/p>\n

Effets secondaires Oro-digestifs<\/h1>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Naus\u00e9es – vomissements<\/h2>\n

Pr\u00e9vention des vomissements anticip\u00e9s<\/p>\n

Donner un anxiolytique la veille au coucher et le matin de la \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 chimioth\u00e9rapie (Alprazolam 0,5mg)<\/p>\n

Pr\u00e9vention des vomissements retard\u00e9s\u00a0:<\/p>\n

Les s\u00e9trons sont inefficaces<\/p>\n

l’Apr\u00e9pitant (Emend*) est efficace\u00a0: 125mg au J1 de la chimio, 80mg au J2 et J3<\/p>\n

En cas d’action \u00e9m\u00e9tisante prolong\u00e9e malgr\u00e9 un protocole de pr\u00e9vention\u00a0:<\/p>\n

M\u00e9toclopramide\u00a0: 1cp pour 20kg de poids toutes les 6 heures +\/- \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0corticoth\u00e9rapie<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mucite<\/h2>\n

Evomucy*<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mycoses buccales<\/h2>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/b>Bains de bouche s\u00e9rum bicarbonat\u00e9, Fungizone*<\/p>\n

Loramyc*<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mucite herp\u00e9tique<\/h2>\n

Zelitrex*<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Diarrh\u00e9e<\/h2>\n

Tarceva*, Nexavar*, Campto*, X\u00e9loda*…<\/p>\n

R\u00e9hydratation<\/p>\n

Ralentisseur du transit (Lop\u00e9ramide)<\/p>\n

Antis\u00e9cr\u00e9toire (Tiorfan*)<\/p>\n

Absorbant (Smecta*)<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Constipation<\/h2>\n

(Zophren*), Cod\u00e9ine, Morphine<\/p>\n

 <\/p>\n

Traitement pr\u00e9ventif<\/p>\n

Prise quotidienne m\u00eame si transit normal<\/p>\n

Associer un laxatif stimulant (Contalax*, Dulcolax*) et un laxatif osmotique<\/p>\n

( Duphalac*, Movicol*, Forlax*)<\/p>\n

Eviter les mucilages (Transilane*, Spagulax*)<\/p>\n

 <\/p>\n

Troubles h\u00e9matologiques et infectieux<\/h1>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/b>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hyperthermie (> 38,5\u00b0C) \u00e0 Bilan sanguin en urgence + ECBU<\/p>\n

 <\/p>\n

Polynucl\u00e9aires neutrophiles > 500 \u00e0 Antibioth\u00e9rapie per os<\/p>\n

 <\/p>\n

Polynucl\u00e9aires neutrophiles < 500 = neutrop\u00e9nie f\u00e9brile = hospitalisation<\/p>\n

 <\/p>\n

An\u00e9mie < 10g en cours de chimio \u00e0 \u00a0\u00a0 EPO<\/p>\n

An\u00e9mie < 8g\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00e0\u00a0 Transfusion<\/p>\n

 <\/p>\n

Thrombop\u00e9nie < 20 000\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00e0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Transfusion<\/p>\n

Thrombop\u00e9nie > 20 000\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00e0\u00a0 Transfusion si signes h\u00e9morragiques<\/p>\n

 <\/p>\n

Leuco\/neutrop\u00e9nie \u00e0 pas de traitement si pas d’hyperthermie<\/p>\n

 <\/p>\n

Effets secondaires Neurologiques<\/h1>\n

Sels de platine\u00a0: carboplatine, cisplatine, oxaliplatine<\/p>\n

Taxol<\/p>\n

Pas \/ peu de traitement efficace, vitaminoth\u00e9rapie B1B6<\/p>\n

Traitement symptomatique (Lyrica*, Neurontin*, Laroxyl*)<\/p>\n

 <\/p>\n

Effets secondaires cutan\u00e9s<\/h1>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Syndrome pied-main<\/h2>\n

Soins de p\u00e9dicurie<\/p>\n

traitements des zones hyperk\u00e9ratosiques (pr\u00e9alables \u00e0 l’initiation du \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 traitement + en cours de traitement)<\/p>\n

Cr\u00e8me \u00e9molliente<\/p>\n

Dexeryl*, Evoskin* gel-cr\u00e8me ou spray<\/p>\n

Dermocortico\u00efde en cas de r\u00e9action inflammatoire douloureuse<\/p>\n

Diprosone*<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Toxicit\u00e9 cutan\u00e9e des th\u00e9rapeutiques cibl\u00e9es<\/h2>\n

Cetuximab (Erbitux*)<\/p>\n

Erlotinib (Tarceva*)<\/p>\n

Panitunumab (Vectibix*)<\/p>\n

 <\/p>\n

= anti EGFR (voies de signalisation responsable de la croissance tumorale)<\/p>\n

 <\/p>\n

Rash acn\u00e9iforme<\/span><\/p>\n

Grade 1<\/p>\n

Toilette savon doux<\/p>\n

Hydratation cutan\u00e9e\u00a0: Dexeryl*<\/p>\n

+\/- Rozex* (m\u00e9tronidazole)<\/p>\n

Grade 2 (folliculite amicrobienne, pustules sur base \u00e9ryth\u00e9mateuse)<\/p>\n

Antibioth\u00e9rapie orale\u00a0: Doxycycline* 100mg \/ 1 mois puis 50mg<\/p>\n

Eryfluid* gel<\/p>\n

Grade 3 (l\u00e9sions confluentes, \u0153d\u00e9mateuses, pr\u00e9judice esth\u00e9tique)<\/p>\n

Antibioth\u00e9rapie orale (grade2)<\/p>\n

+\/- cortico\u00efdes locaux de classe 3 (Loco\u00efd*)<\/p>\n

Grade 4 (dermite exfoliative ou ulc\u00e9ration, l\u00e9sions suintantes et \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 cro\u00fbteuses)<\/p>\n

Avis dermatologique\u00a0: pansement gras quotidien, d\u00e9tersion des \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 cro\u00fbtes…<\/p>\n

 <\/p>\n

X\u00e9rose cutan\u00e9e<\/span><\/p>\n

Dexeryl*, Evoskin*<\/p>\n

 <\/p>\n

Fissures et crevasses palmo-plantaires<\/span><\/p>\n

Pr\u00e9paration magistrale \u00e0 base de baume du commandeur\u00a0:<\/p>\n

Baume du commandeur 5g<\/p>\n

Glyc\u00e9rine 5g<\/p>\n

Excipial* pommade qsp 50g (en l’absence de sp\u00e9cialit\u00e9 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00e9quivalente)<\/p>\n

 <\/p>\n

P\u00e9rionyxis<\/span><\/p>\n

B\u00e2tonnet de nitrate d’argent<\/p>\n

Dermocortico\u00efde de classe 4<\/p>\n

D\u00e9sinfection \u00e0 l’H\u00e9xom\u00e9dine*<\/p>\n

+\/- Doxycycline<\/p>\n

 <\/p>\n

Toxicit\u00e9 R\u00e9nale<\/h1>\n

 <\/p>\n

Cisplatine<\/p>\n

Eviter d’associer des th\u00e9rapeutiques n\u00e9phrotoxiques<\/p>\n

Surveillance de la fonction r\u00e9nale<\/p>\n

 <\/p>\n

Asth\u00e9nie<\/h1>\n

 <\/p>\n

Plusieurs facteurs<\/p>\n

Le type de cancer et le stade \u00e9volutif, les traitements<\/p>\n

L’an\u00e9mie<\/p>\n

La douleur<\/p>\n

La d\u00e9pression, les troubles du sommeil<\/p>\n

La d\u00e9nutrition<\/p>\n

Les probl\u00e8mes sociaux<\/p>\n

 <\/p>\n

 <\/p>\n

Une activit\u00e9 physique adapt\u00e9e, d’intensit\u00e9 faible \u00e0 mod\u00e9r\u00e9e pendant et apr\u00e8s le \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 traitement am\u00e9liore la qualit\u00e9 de vie<\/p>\n

B\u00e9n\u00e9fice sur l’anxi\u00e9t\u00e9, sur la d\u00e9pression, sur le sommeil, sur l’image du corps, \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 diminution de la sensation de fatigue<\/p>\n

 <\/p>\n

Effets sur la survie dans le cancer du sein\u00a0:<\/p>\n

R\u00e9duction du risque de mortalit\u00e9 globale de 18 \u00e0 41% selon les \u00e9tudes<\/p>\n

R\u00e9duction du risque de d\u00e9c\u00e8s par cancer du sein de 34%<\/p>\n

R\u00e9duction du risque de r\u00e9cidive de 24%<\/p>\n

Effets sur la survie dans le cancer colique<\/p>\n

Effets pr\u00e9ventifs<\/p>\n

 <\/p>\n

<\/b>Cas Clinique 1\u00a0: Surveillance du cancer du sein<\/b><\/p>\n

 <\/p>\n

Recommandations (HAS, SOR, FNCLCC)<\/p>\n

Examen clinique tous les 6 mois pendant 5 ans, puis annuellement<\/p>\n

80% des r\u00e9cidives surviennent au cours de cette p\u00e9riode<\/p>\n

Examen clinique = diagnostic dans \u00be des cas<\/p>\n

Associer une mammographie annuelle<\/p>\n

= R\u00e9cidive locale ou controlat\u00e9rale<\/p>\n

 <\/p>\n

La recherche de m\u00e9tastases n’est pas l’objectif de la surveillance<\/p>\n

Le diagnostic pr\u00e9coce des m\u00e9tastases n’a pas d’impact favorable sur la \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 survie<\/p>\n

la mammographie est le seul examen compl\u00e9mentaire de r\u00e9alisation \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 syst\u00e9matique qui ait montr\u00e9 un int\u00e9r\u00eat<\/p>\n

L’IRM mammaire a son int\u00e9r\u00eat en cas de doute diagnostique<\/p>\n

 <\/p>\n

Un bilan (scanner, scintigraphie) sera r\u00e9alis\u00e9 uniquement en cas de point \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 d’appel<\/p>\n

 <\/p>\n

Le dosage du CA 15.3 n’est pas recommand\u00e9<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

<\/b>Cas Clinique 2\u00a0: Surveillance du cancer colique<\/b><\/p>\n

 <\/p>\n

Interrogatoire et examen clinique<\/p>\n

Tous les 3 mois pendant 3 ans, puis tous les 6 mois pendant 2 ans<\/p>\n

 <\/p>\n

Examens compl\u00e9mentaires<\/p>\n

Scanner thoraco-abdomino-pelvien avec injection (fonction du stade) \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 tous les 3 \u00e0 6 mois pendant 2 ans puis annuellement pendant 3 ans<\/p>\n

 <\/p>\n

TEP indiqu\u00e9e pour la localisation des r\u00e9cidives en cas d’\u00e9l\u00e9vation \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 confirm\u00e9e de l’ACE et n\u00e9gativit\u00e9 du reste du bilan<\/p>\n

 <\/p>\n

Endoscopie<\/p>\n

Si colo incompl\u00e8te ou de mauvaise qualit\u00e9 en pr\u00e9-op\u00e9ratoire\u00a0: \u00e0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 refaire dans les 6 mois post-op\u00e9ratoires<\/p>\n

Contr\u00f4le \u00e0 2 ou 3 ans puis tous les 5 ans si normale<\/p>\n

 <\/p>\n

Biologie<\/p>\n

Dosage de l’ACE tous les 3 mois durant 2 ans puis tous les 6 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 mois pendant 3 ans. (recommandations HAS 2012\u00a0; tous les 3 mois \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 les 3 premi\u00e8res ann\u00e9es)<\/p>\n

 <\/p>\n

 <\/p>\n

<\/b>Cas clinique 3\u00a0: prise en charge de l’\u00e9tat nutritionnel<\/b><\/p>\n

\u00a0<\/b><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Evaluation de l’\u00e9tat nutritionnel<\/b><\/p>\n

 <\/p>\n

40 \u00e0 60 % des patients hospitalis\u00e9s pour un cancer sont d\u00e9nutris<\/p>\n

Toute alt\u00e9ration de l’\u00e9tat nutritionnel augmente la morbidit\u00e9 et constitue un \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 facteur pronostique ind\u00e9pendant p\u00e9joratif de survie<\/p>\n

 <\/p>\n

Evaluation clinique<\/span><\/p>\n

 <\/p>\n

\u009fPoids de forme<\/p>\n

\u009fpoids actuel<\/p>\n

\u009f% de perte de poids<\/p>\n

le seuil de 10% de perte de poids = valeur pronostique \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 p\u00e9jorative<\/p>\n

Rapidit\u00e9 d’installation de la perte de poids<\/p>\n

Perte de poids de 2% en 1 semaine, m\u00eame valeur \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pronostique p\u00e9jorative qu’une perte de poids de 5 % en \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 1 mois ou 10% en 6 mois<\/p>\n

Un patient ob\u00e8se peut \u00eatre d\u00e9nutri<\/p>\n

 <\/p>\n

Evaluation Biologique <\/span><\/p>\n

 <\/p>\n

\u009fAlbumin\u00e9mie<\/p>\n

\u00bd vie de 20 jours, permet de suivre l’\u00e9volution \u00e0 long terme<\/p>\n

Taux < 35g\/l = d\u00e9nutrition mod\u00e9r\u00e9e, < 30 = d\u00e9nutrition s\u00e9v\u00e8re<\/p>\n

Variable selon l’\u00e9tat inflammatoire (CRP)<\/p>\n

Facteur pronostique d’\u00e9v\u00e8nement infectieux et de mortalit\u00e9 en \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 post-op\u00e9ratoire<\/p>\n

 <\/p>\n

\u009fPr\u00e9-albumin\u00e9mie<\/p>\n

\u00bd vie courte\u00a0: 2 jours<\/p>\n

Permet d’identifier les fluctuations rapides du statut nutritionnel<\/p>\n

< 20g\/l\u00a0: d\u00e9nutrition mod\u00e9r\u00e9e<\/p>\n

< 10g\/l\u00a0: d\u00e9nutrition s\u00e9v\u00e8re<\/p>\n

 <\/p>\n

Prise en charge \u00e0 domicile de premi\u00e8re intention<\/span>\u00a0:<\/p>\n

 <\/p>\n

la compl\u00e9mentation orale<\/p>\n

Elle permet seulement de compl\u00e9ter l’alimentation orale \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 habituelle et non la remplacer Elle existe sous diff\u00e9rents \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ar\u00f4mes et diff\u00e9rentes textures adapt\u00e9es aux troubles de la \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 d\u00e9glutition<\/p>\n

 <\/p>\n

Indications<\/p>\n

D\u00e9nutrition mod\u00e9r\u00e9e ou s\u00e9v\u00e8re<\/p>\n

Augmentation des besoins prot\u00e9ino-\u00e9nerg\u00e9tiques (cancer, \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 escarres…)<\/p>\n

Troubles de mastication, dysphagie<\/p>\n

Renutrition pr\u00e9 et\/ou post-op\u00e9ratoire<\/p>\n

Sa posologie est de 1 \u00e0 2 par jour \u00e0 adapter en fonction des \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 besoins. Au-del\u00e0 l’effet peut \u00eatre d\u00e9l\u00e9t\u00e8re sur l’app\u00e9tit ou sur la \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 fonction r\u00e9nale dans certaines pathologies<\/p>\n","protected":false},"excerpt":{"rendered":"

Les effets secondaires de la chimioth\u00e9rapie FMC Mardi 4 Juin 2013 Article VO \u00e0 t\u00e9l\u00e9charger :\u00a0EffetsSecondairesChimioTTT T\u00e9l\u00e9charger le Diaporama :\u00a0effetsSecondairesChimioDiapoR Rem\u00e8des locaux suite Chimio :\u00a0RMD-Peau-ChimioTTT \u00a0 Docteur Nathalie Leriche C H Dron Tel\u00a0: 03 20 69 44 88 Fax\u00a0: 03 … Continuer la lecture →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","footnotes":""},"categories":[8],"tags":[],"class_list":["post-468","post","type-post","status-publish","format-standard","hentry","category-publications"],"_links":{"self":[{"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/posts\/468","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/comments?post=468"}],"version-history":[{"count":8,"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/posts\/468\/revisions"}],"predecessor-version":[{"id":481,"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/posts\/468\/revisions\/481"}],"wp:attachment":[{"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/media?parent=468"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/categories?post=468"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.fmc-tourcoing.org\/new\/wp-json\/wp\/v2\/tags?post=468"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}