Symptom
Go to emergency now
Call / message the duty mobile today
Fever
Temperature 38.0°C (100.4°F) or higher, even once. Or shivering and chills.
37.5–37.9°C (99.5–100.2°F). Check again after 1 hour. If it rises to 38°C, go to emergency.
Vomiting
More than 3 times in 24 hours, or unable to keep down water or medicines.
1–2 times in a day, but able to drink fluids.
Loose stools (diarrhoea)
4 or more loose stools in 24 hours, or any loose stools with blood, fever or dizziness.
2–3 loose stools in a day.
Breathlessness
Breathless at rest or while talking, sudden breathlessness, or breathlessness with chest pain.
New breathlessness only on climbing stairs or walking fast.
Bleeding
Vomiting blood, black or bloody stools, blood in urine, coughing blood, nosebleed not stopping after 10 minutes of pressure, or many new tiny red spots on the skin.
Slight gum bleeding while brushing, or a few small bruises.
Pain
Severe pain not relieved by your prescribed pain medicines, or a sudden severe headache.
Pain controlled, but needing more doses than prescribed.
Weakness
Unable to get out of bed or walk, fainting, or dizziness on standing.
More tired than usual, but managing daily activities.
Mouth ulcers
Unable to eat or drink, or unable to swallow saliva.
Painful ulcers, but able to drink and eat soft food.
Urine
No urine for 12 hours.
Passing less urine than usual.
Constipation
No stools for 3 days with vomiting or a swollen, painful abdomen.
No stools for 2–3 days, otherwise well.
Always go to the emergency department immediately for:
- Confusion, unusual drowsiness or difficulty waking up
- Fits (seizures)
- A sudden fall or any head injury
- Sudden weakness of the face, arm or leg, or slurred speech
- Chest pain
- Swelling of the face or lips, or difficulty breathing, during or after treatment
- Painful swelling of one leg
- Redness, swelling, pain or pus around a chemo port or PICC line
If you are far from KIMS, go to the nearest hospital emergency department. Do not delay travelling to call first.
What is febrile neutropenia?
- Chemotherapy lowers the neutrophils, the white blood cells that fight infection.
- They are usually lowest about 7 to 14 days after chemotherapy.
- Febrile neutropenia means fever when the neutrophils are low.
- With low neutrophils, the body cannot show the usual signs of infection. Fever may be the only sign.
- The infection can become serious within hours. It needs antibiotics through a drip, ideally within 1 hour of reaching the hospital.
- Temperature 38.0°C (100.4°F) or higher
- Do not wait for it to settle. Do not take only paracetamol and stay home.
- Call / message the duty mobile and go to the nearest emergency department
- Tell them: “I am on chemotherapy”
- Blood test and antibiotics, ideally within 1 hour
When you go to the emergency department
- Tell the staff you are on chemotherapy, and the date of your last cycle
- Carry your latest discharge summary or chemotherapy record
- Carry a list of all your medicines
- Check your temperature before taking paracetamol, as paracetamol can hide a fever
Video consultations and second opinions are not suitable for emergencies.