Anesthesia Considerations 

Tumor Lysis Syndrome

 

 

Considerations

 

• Severe acute life threatening condition with potential for multi-system failure:

  • Hyperkalemia & secondary arrhythmias

  • Hyperuricemia & acute renal failure

  • Hypocalcemia & risk of seizures, tetany

  • Hyperphosphatemia & prolonged QT interval 

• Underlying hematologic malignancy:

  • 4M’s (mass effects, metastases, metabolic abnormalities, medications) 

• Chemotherapy &/or radiation with end-organ dysfunction

 

 

Treatment

 

• Need for admission to high acuity setting

• Rapidly diagnose & treat metabolic derangements

• Prevent & support renal failure:

  • Volume loading (20 mL/kg) & 1.5-2 times maintenance

  • If volume overloaded → diuretics, potentially dialysis

• Acute treatment of hyperkalemia & life threatening arrhythmias

• Rasburicase/allopurinol for hyperuricemia