# Situation: The nurse works in a hospital chemotherapy day unit that treats adults with solid tumors. A 57-year-old man with colon cancer is receiving his first oxaliplatin infusion. Shortly after drinking iced water, he says his throat feels tight and it is hard to swallow. His voice is normal, and he has no stridor, wheeze, rash, or lip swelling. His blood pressure is 126/80 mmHg and his oxygen saturation is 98% on room air. What should the nurse do?

> source: MyMerci (mymerci.kr)  
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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: The nurse works in a hospital chemotherapy day unit that treats adults with solid tumors.

A 57-year-old man with colon cancer is receiving his first oxaliplatin infusion. Shortly after drinking iced water, he says his throat feels tight and it is hard to swallow. His voice is normal, and he has no stridor, wheeze, rash, or lip swelling. His blood pressure is 126/80 mmHg and his oxygen saturation is 98% on room air. What should the nurse do?

## 보기

1. Give the prescribed antihistamine and continue at the same rate
2. Stop the infusion and give intramuscular adrenaline (epinephrine)
3. Stop the infusion and prepare for emergency airway support
4. Reassure him and offer warm drinks instead of cold ones **✔ 정답**

**정답: 4**

## 해설

Oxaliplatin can cause acute throat dysesthesia, a cold-triggered sensory neuropathy that feels like throat tightness or difficulty swallowing. With a normal voice and no stridor, wheeze, rash, swelling, hypotension, or desaturation, this is not anaphylaxis. The nurse reassures him and has him avoid cold drinks and objects; he is still watched for true hypersensitivity, which oxaliplatin can also cause.

## 심화 해설

Clinical situation

A 57-year-old man receiving his first oxaliplatin infusion reports throat tightness and difficulty swallowing immediately after drinking iced water. His voice is normal, and there is no stridor, wheeze, rash, lip swelling, hypotension, or desaturation. The priority is to recognize this as a cold-triggered sensory phenomenon rather than anaphylaxis.

Why the answer is reassurance and warm drinks

Oxaliplatin causes a distinctive acute, cold-sensitive neurotoxicity. Within hours of infusion, exposure to cold can trigger paresthesias, jaw tightness, and a sensation of throat or laryngeal tightness [2]. The underlying mechanism is transient peripheral nerve hyperexcitability, not mucosal edema or bronchospasm. Because the patient’s voice is normal and there is no stridor, wheeze, rash, swelling, hypotension, or oxygen desaturation, the presentation does not meet criteria for anaphylaxis. The correct nursing action is to reassure the patient and advise avoidance of cold drinks and cold objects while continuing to monitor for true hypersensitivity.

Distinguishing acute dysesthesia from anaphylaxis

Oxaliplatin can cause both acute cold-triggered dysesthesia and true hypersensitivity reactions, so the nurse must differentiate them carefully. The table below compares the key features.

| Feature | Cold-triggered dysesthesia | Anaphylaxis |
| --- | --- | --- |
| Trigger | Cold drink, cold air, cold object | Drug exposure, often after repeated cycles |
| Voice | Normal | Hoarse or changed |
| Stridor or wheeze | Absent | May be present |
| Rash, urticaria, lip or tongue swelling | Absent | Often present |
| Blood pressure | Stable | May drop |
| Oxygen saturation | Normal | May fall |
| Nursing action | Reassure, remove cold trigger, warm drinks | Stop infusion, emergency airway support, adrenaline |

Watch out! The absence of objective airway signs is the key discriminator. A sensation of throat tightness alone, with a normal voice and no stridor, is not an indication for adrenaline or emergency airway equipment.

Why the other options are incorrect

Giving an antihistamine and continuing the infusion at the same rate is not indicated because the symptoms are not allergic and continuing cold exposure may worsen the dysesthesia. Stopping the infusion and giving intramuscular adrenaline is inappropriate without evidence of anaphylaxis. Stopping the infusion and preparing for emergency airway support is overly aggressive when the airway is objectively patent.

Clinical monitoring and patient education

The patient should be advised to avoid cold drinks, ice, and cold air for several days after each oxaliplatin infusion because the acute neurotoxicity is transient but reproducible with cold exposure [2]. At the same time, the nurse must continue to observe for delayed hypersensitivity reactions, which oxaliplatin can also cause and which may appear after multiple cycles . Reassurance and warm drinks address the immediate symptom, but ongoing surveillance for true hypersensitivity remains essential.References (research sources)

- [2]Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy.Research articleLehky TJ, Leonard GD, Wilson RH, Grem JL, Floeter MK (2004) · DOI: 10.1002/mus.10559

## 임상 시나리오

Oxaliplatin Cold Dysesthesia vs AnaphylaxisRapid bedside differentiation and nursing action
Oxaliplatin can cause acute cold-triggered dysesthesia within hours of infusion. Cold drinks or cold air may provoke throat tightness, jaw spasm, or paresthesias without airway edema.

Key reassuring findings: normal voice, no stridor, no wheeze, no rash or lip swelling, stable blood pressure, and oxygen saturation 98% on room air. These exclude anaphylaxis.

Nursing action: reassure the patient, offer warm drinks, and advise avoiding cold drinks, ice, and cold objects during and after the infusion. Continue monitoring for true hypersensitivity.

CautionDo not give adrenaline or stop for airway support unless stridor, wheeze, voice change, rash, hypotension, or desaturation develops. Oxaliplatin can still cause true anaphylaxis, especially after repeated cycles, so remain vigilant.

## 핵심 개념

- **Oxaliplatin-induced cold dysesthesia** — Acute, cold-triggered sensory neuropathy causing transient paresthesias, jaw tightness, or throat tightness without airway compromise.
- **Anaphylaxis** — Severe systemic hypersensitivity reaction with airway swelling, stridor, wheeze, rash, hypotension, or desaturation requiring immediate adrenaline.
- **Stridor** — High-pitched inspiratory sound indicating upper airway narrowing or obstruction; absent in cold-triggered dysesthesia.
- **Sensory neuropathy** — Nerve dysfunction causing abnormal sensations such as tingling, tightness, or dysesthesia without motor or autonomic involvement.
- **Hypersensitivity reaction** — Immune-mediated reaction to a drug that may range from mild rash to life-threatening anaphylaxis; can occur with oxaliplatin after repeated cycles.

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