# Tumor Lysis Syndrome
-- ABCs: does the patient have severe electrolyte derangements requiring frequent monitoring and telemetry?
-- Chart Check: tumor type, last treatment and date, h/o CKD, baseline LDH and uric acid
-- Can't Miss: hypocalcemia, hyperkalemia, renal failure
-- Admission Orders: strict I/O, telemetry, CBC, BMP, Phos, Uric Acid LDH
-- Initial Treatment to Consider: aggressive fluids, address hyperkalemia, decide on need for rasburicase
-- History: *** tumor type, last treatment and date, CKD, elevated LDH or uric acid at baseline
-- Clinical/Exam: *** hypocalcemia (weakness, tetany, arrythmia), oliguria
-- Data: *** Uric Acid, LDH, creatinine, K, Phos, Calcium - Cairo Bishop - uric acid>8, K>6, Phos>4.5, Ca<7; if 2+ criteria met with 7 days of therapy OR 1 lab value and Cr 1.5x ULN, arrhythmia, seizure
-- EKG - baseline in case of hyperkalemia or other electrolyte disturbances
-- trend q6-8 BMP, Phos, Uric Acid, LDH
-- trend UOP, continuous telemetry
-- hydrate with NS - 2-3L per day
-- furosemide PRN for UOP >100cc/hr
-- Allopurinol ppx 300-600mg/day 24-48 hours before chemo, then until hyperuricemia resolved
-- Rasburicase 3-6mg IV in specific situations (high risk by # WBC, renal failure, rising uric acid or creatinine, and can’t hydrate)
-- Dialysis may be needed if Ca x Phos >70
PDF coming soon!
The highest risk tumors are ALL, AML, CLL, and bulky solid tumors (NHL, DLBCL). Trend BMP, Phos, Uric Acid, and LDH. The goal is to avoid dangerous electrolyte derangements (hyperkalemia, severe hypocalcemia), and prevent renal failure. Hydrate aggressively and diurese if need be. Allopurinol is used prophylactically and prevents xanthine and uric acid formation (which are both neprhotoxic) whereas rasburicase turns uric acid into allantoin which is harmlessly excreted.