Tumor Lysis Syndrome

Question 1

Signs of Tumor Lysis Syndrome

Answer 1

hyperuricemia

hyperkalemia

hyperphosphatemia

hypocalcemia

RENAL FAILURE
ARRHYTHMIAS
SEIZURES
DEATH

urate and phosphate can precipitate, and calcium can bind the phosphate and clog the kidneys

Question 2

when do TLS sx appear?

Answer 2

within 12 - 72 hours of chemo

especially with large tumor burden (leukemia, lymphoma, advanced dx, LDH > 600)

Question 3

How to prevent TLS

Answer 3

IV hydration (12 - 24 hrs before if high risk)

manage hyperuricemia

monitor electrolytes q 6- 8 hrs

consider diuresis

Question 4

Allopurinol

Answer 4

for hyperuricemia management

start 2 - 3 days before chemo

continue for 10 - 14 days

dose adjust if CrCl < 30

Monitor:

• rash
• SJS
• interstitial nephritis
• fever

Question 5

Rasburicase

Answer 5

urate oxidase enzyme for hyperuricemia

do not use in pts with G6PD deficiency

expensive

AEs:

• hypersensitivity/anaphylaxis
• methemoglobinemia
• hemolysis

Question 6

Calcium Chloride

Answer 6

for hyperkalemia

1 - 2 g only for cardiac symptoms

vesicant

Question 7

Glucose and insulin

Answer 7

for hyperkalemia

Question 8

kayexalate

Answer 8

for hyperkalemia

Question 9

calcium gluconate

Answer 9

for hypocalcemia

only if symptomatic, give 1 gram

correct phosphate, that should fix calcium

Question 10

Calcium acetate

Answer 10

phosphate binder for hyperphosphatemia

Question 11

Sevelamer

Answer 11

phos binder for hyperphosphatemia

Question 12

When is hemodialysis indicated?

Answer 12

K+ > 6
uric acid > 10
Scr > 10
PO4 > 10
Ca * PO4 > 80
symptomatic hypocalcemia
volume overload
uremia
anuric renal failure