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