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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
Tumor lysis syndrome is characterised by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia and is caused by the destruction of a large no. of rapidly proliferating neoplastic cells.
Acidosis and acute renal failure may also develop.
It is often associated with burkitt's lymphoma, ALL & other rapidly proliferating lymphomas. It is associated with administration of glucocorticoids, hormonal agents like letrozole & tamoxifen; monoclonal antibodies like rituximab.
Hyperuricemia is produced due to destruction of malignant cells. The uric acid can precipitate in tubules , medulla and collecting ducts of the kidney, leading to renal failure.
Hyperphosphatemia is due to release of intracellular pool of phosphate due to tumor lysis. This causes reciprocal depression of calcium. Deposition of calcium and phosphorus in the kidney can cause renal failure.
Prognosis is excellent and renal function recovers after the uric acid is lowered to <10mg/dl.
Investigations
Investigations
RFT
Electrolytes
USG/ CT to look for any obstructive cause for renal failure
LDH will be elevated.
Management
Hydration : NS or ½ NS at 3000ml/m2 per day .
Sodium bicarbonate can be administrated to keep pH>7.0.
Allopurinol may be started 3 days prior to chemotherapy and continued for 10-14 days.
Rasburicase
It is recombinant urate oxidase .It catalyzes enzymatic coversion of poorly soluble uric acid into inactive and more soluble metabolite (allantoin).
Indication : Serum uric acid > 8mg/dl or serum creatinine > 1.8mg/dl inspite of hydration for 24 -48hrs.
Dose: 0.2mg/kg over 30 min upto 5 days.
Administration and storage : Dilute with diluent available with the kit. Store the diluted drug at 2-8C for maximum 24hrs.
Adverse effects : Hypersensitivity, bronchospasm, hypoxemia, hypotension
Contraindication : G6PD deficiency
Dialysis
Indication:
Serum uric acid >10 mg/dl
Serum creatinine >10mg/dl
Serum phosphate > 10mg/dl or increasing
Symptomatic hypocalcemia.
Reference
Tinitinalli
Harrison
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor