Tumor Lysis Syndrome Essay
Sorry, but copying text is forbidden on this website!
Tumor Lysis Syndrome by NinjaMom Tumor Lysis Syndrome is a series of metabolic derangements which may begin shortly after the onset of treatment of malignancies. It can lead to any of the following: · hyperphosphatemia· lactic acidosis (metabolic acidosis) · hypocalcemia· hyperuricemia · hyperkalemia· acute renal failure Tumor Lysis Syndrome (TLS): · is caused by the destruction of many rapidly proliferating neoplastic cells · is most commonly associated with a Burkitt’s lymphoma or acute lymphocytic leukemia · can occur after treatment of nearly any malignancy · occurs shortly (1-5 days) after onset of chemotherapy can occur spontaneously, but this is rare There are no definite parameters to diagnosing TLS, but there is a guideline as to how to measure disease severity.
This is the Cairo-Bishop method. Laboratory TLS – two or more of the following: · uric acid level ;gt; 8· potassium level ;gt; 6 · phosphorus level ;gt; 4. 5· calcium level ;lt; 7 Clinical TLS – any of the above laboratory values with an elevated serum creatinine, a new arrhythmia, seizure or sudden death Hyperphosphatemia · caused by the release of intracellular phosphate pools within tumor cells · causes a reciprocal decrease in serum calcium, which then causes the deposition of calcium phosphate crystals in the renal tubules and in the microvasculature, and can lead to acute renal failure · treat with oral phosphate binders Hypocalcemia · usually a reciprocal decrease caused by hyperphosphatemia · QT prolongation · positive Chvostek and Trousseau’s signs · bronchospasm, seizures, anxiety, tetany, encephalopathy, unexplained dementia or psychosis, parasthesias · often resolves without intervention as the phosphate levels return to normal · do NOT correct unless severe neurological symptoms present as this may predispose the patient to hypercalcemia as the phosphate levels normalize
Hyperkalemia · caused by intracellular potassium release from tumor lysis · worsed with a metabolic acidosis · shortened QT interval, peaked T waves, flattened P waves, prolonged PR interval, wide QRS, deep S wave, sine waves, ventricular arrhythmias, asystole, death · often the first life-threatening abnormality identified · treat with restriction of dietary potassium, kayexelate, and IV glucose and insulin · if K > 6. 5, calcium gluconate or calcium carbonate may be given for cardioprotecion Hyperuricemia · caused by the rapid turnover of nucleic acids uric acid can precipitate in the tubules, medulla, and collecting ducts of the kidney · elevated levels can lead to nausea/vomiting, arthralgias, and lethargy · worsened by a metabolic acidosis · treat with allopurinol · may treat with rasburicase · may magnify clinical hypocalcemia · if prior treatment ineffective, acetazolamide may be used Metabolic Acidosis · caused by release of endogenous intracellular acids · elevated anion gap · decreased serum bicarbonate levels · decreased uric acid solubility · increased calcium phosphate solubility Acute Renal Failure · oligoanuric · causes volume overload, pulmonary edema precipitated by uric acid crystallization, calcium phosphate crystallization · if conservative medical management does not correct these abnormalities, emergent dialysis is warranted to prevent permanent kidney damage The likelihood of developing TLS depends on several factors: · tumor burden· renal function · uric acid level·
LDH level · tumor sensitivity to treatment· elderly age Pre-treatment care: · CBC· LDH level · CMP· uric acid level · ionized calcium· hydration ·possible pre-alkalinization of the urine Post-treatment care: · close monitoring for 48-72 hours after treatment continuous cardiac monitoring · hydration · BUN’s TID · measurement of urine pH TID · dialysis if indicated References Berkow, Robert, M. D. et al, eds. “Tumor Lysis Syndrome. ” The Merck Manual of Diagnosis and Therapy. 13th ed. New Jersey: Merck ; Co. , Inc. 1977. Braunwald, Eugene, M. D. et al, eds. “Tumor Lysis Syndrome. ” Harrison’s Principles of Internal Medicine. 15th ed. New York: McGraw-Hill, 2001. Fernandez, Pedro, M. D. , Richard Larson, M. D. , and Zalman Agus, M. D. “Tumor Lysis Syndrome. ” www. uptodate. com 2007. Ikeda, Alan, M. D. et al. “Tumor Lysis Syndrome. ” www. emedicine. com. 2006.