Tumour Lysis Syndrome Flashcards
define tumour lysis syndrome?
oncologic emergency that is caused by massive tumour cell breakdown with the release of large amounts intracellular components (potassium, phosphate, and nucleic acids)
What are 5 possible features of laboratory tumour lysis syndrome?
Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, azotemia
what are the three features of clinical tumour lysis syndrome
renal insufficiency, cardiac arrythmias, seizures
How do you dx laboratory tumour lysis syndrome?
2 or more of; hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, azotemia
how do you dx clinical tumour lysis syndrome?
any of the lab TLS plus two or more of; renal insufficiency, cardiac arrythmias, seizures
Risk for Tumour Lysis (LOW, INTERMED, HIGH) 1. solid tumours except neuroblastoma and germ cell tumours 2. AML with WBC<25000 3. LDH <2xULN
Low Risk
Risk for Tumour Lysis (LOW, INTERMED, HIGH) 1. Neuroblastoma 2. germ cell tumours, 3. AML with WBC<25000 and LDH>2xULN 4. AML with WBC >25000 <100,000 and LDH >2 ULN 5. ALL with WBC <100,000 and LDH <2
intermediate
Risk for Tumour Lysis (LOW, INTERMED, HIGH) 1. Burkitts lymphoma/leukemia 2. ALL with WBC <100,000 and lDH >2 ULN 3. ALL with WBC >100,000
High risk
What are the initial Ix you do for TLS
CBC + diff, Lytes, Extended lytes (ca, mag, phos), renal function, uric acid, LDH, LFT, total protein, albumin
What is the treatment for TLS?
Hyperhydration, monitoring, dependent on symptoms and disturbances treatment is different (other cards will address)
What do you treat hyperuricemia in TLS with?
allopurinol or rasburicase (in discussion with attending)
What do you treat hyperkalemia in TLS with?
sodium polystyrene sulfonate, calcium gluconate, insulin
what do you treat hyperphosphatemia in TLS with?
aluminum hydroxate, sevelamer hydrochloride
What do you treat hypocalcemia in TLS with?
calcium gluconate
