Tumor Lysis Syndrome

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  • Topic: Metabolic acidosis, Nephrology, Uric acid
  • Pages : 4 (604 words )
  • Download(s) : 7
  • Published : May 26, 2013
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Tumor Lysis Syndrome
by NinjaMom

Tumor Lysis Syndrome is a series of metabolic derangements which may begin shortly after the onset of treatment of malignancies. It can lead to any of the following:

· hyperphosphatemia· lactic acidosis (metabolic acidosis)
· hypocalcemia· hyperuricemia
· hyperkalemia· acute renal failure

Tumor Lysis Syndrome (TLS):

· is caused by the destruction of many rapidly proliferating neoplastic cells
· is most commonly associated with a Burkitt's lymphoma or acute lymphocytic leukemia
· can occur after treatment of nearly any malignancy
· occurs shortly (1-5 days) after onset of chemotherapy
· can occur spontaneously, but this is rare

There are no definite parameters to diagnosing TLS, but there is a guideline as to how to measure disease severity. This is the Cairo-Bishop method.

Laboratory TLS - two or more of the following:

· uric acid level > 8· potassium level > 6
· phosphorus level > 4.5· calcium level < 7

Clinical TLS - any of the above laboratory values with an elevated serum creatinine, a new arrhythmia, seizure or sudden death

Hyperphosphatemia

· caused by the release of intracellular phosphate pools within tumor cells
· causes a reciprocal decrease in serum calcium, which then
· causes the deposition of calcium phosphate crystals in the renal tubules and in the microvasculature, and can lead to acute renal failure
· treat with oral phosphate binders

Hypocalcemia

· usually a reciprocal decrease caused by hyperphosphatemia
· QT prolongation
· positive Chvostek and Trousseau's signs
· bronchospasm, seizures, anxiety, tetany, encephalopathy, unexplained dementia or psychosis, parasthesias
· often resolves without intervention as the phosphate levels return to normal
· do NOT correct unless severe neurological symptoms present as this may predispose the patient to hypercalcemia as the phosphate levels normalize...
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