TLS

Question 1

TLS risk factors

Answer 1

• renal dysfunction
• hyperuricemia
• high tumor burden / growth rate
• chemosensitivity of malignancy
• hypovolemia
• hypotension
• acidic urine

Question 2

Diagnostic criteria

Answer 2

2 or more of:

• hyperurecemia ( > 8)
• hyperK ( > 6)
• hyperphos ( > 4.5)
• hypoCa ( < 7)

1 of:

• acute renal failure
• cardiac arrhythmia
• seizure

Question 3

Pretreatment for patients at high risk

Answer 3

• IV saline - urine outpt of approx 2mL/kg/hr)

- hyperuricemia at onset - allopurinol or rasburicase (ras more effective but $$$)

Question 4

Treatment

Answer 4

• labs q4hrs - fix electrolytes
• maybe ICU depending on severity
• tele - arrhythmias
• fluids
• rasburicase - esp if renal dysfunction
• dialysis as last resort

Question 5

Illness script

Answer 5

• usually in NHL or acute leukemia (fast growing, chemo sensitive)
• electrolyte abnormalities
• first or second chemo tx (3-7 d after start of tx) - renal dysfxn, arrhythmias, seizures

Question 6

Research - rasburicase for patients at risk or tx of TLS hyperuricemia

Answer 6

• single dose rasburicase (3mg dose) effective for lowering hyperuricemia < 12 mg/dL for tx
• single dose vs 5 day therapy for PTs at risk - single dose effective for most patients to keep UA levels low during tx