Tumor Lysis Syndrome Flashcards
Pt’s with Burkitt’s lymphoma and high Cr (1.7) and LDH of 2500 and urate level of 13.3 what do you worry about?
Tumor Lysis syndrome
To treat someone in tumor lysis syndrome what is the FIRST medication you start with IV hydration?
rasburicase and IV hydration +/- diuretics
Don’t start chemotherapy w/ this because you will worsen his tumor lysis syndrome and person will be on HD
What conditions predisposes/ who gets tumor lysis syndrome?
Burkitt’s lymphoma, leukemia, bulky large B cell lymphoma can occur spontaneously or with renal insufficiency
When to use rasburicase to treat tumor lysis syndrome?
if uric acid is already increased or with renal insufficiency
When to use allopurinol to treat tumor lysis syndrome?
if uric acid is low and kidney function is intact
what is tumor lysis syndrome?
large burden of tumor undergoes rapid destruction with release of intracellular contents into blood stream see electrolyte abnormalities and metabolic abnormalities that can cause AKI (calcium phosphate precipitation in renal tubules) and arrhythmias (calcium phosphate precipitation in heart), seizures, and death
Definition of TLS is by 2 of the following:
- uric acid >8 (or 25% baseline value increase)
- potassium >6 (or 25% baseline value increase)
- phosphorus >4.5 or (or 25% baseline value increase)
- calcium <7 or (or decrease 25% baseline value increase)
prevention of TLS is based on risk stratification and low risk pts need
hydration and close monitoring - aim for urine output of 80-100 cc/hr
high risk pts for TLS should get
IV hydration and 5-7 days of prophylactic rasburicase (recombinant uric acid doxidase that immediately catalyzes uric acid conversion into water soluble allantoin) and rapidly lowers uric acid levels
when does someone get HD for TLS
anuria, volume overload, severe electrolyte abnormalities (persistent hyper K and calcium phosphate product >70mg/dl despite optimal therapy
