Tumor Lysis Syndrome
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
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
References: Berkow, Robert, M.D. et al, eds. "Tumor Lysis Syndrome." The Merck Manual of Diagnosis and Therapy. 13th ed. New Jersey: Merck & Co., Inc. 1977. Braunwald, Eugene, M.D. et al, eds. "Tumor Lysis Syndrome." Harrison 's Principles of Internal Medicine. 15th ed. New York: McGraw-Hill, 2001. Fernandez, Pedro, M.D., Richard Larson, M.D., and Zalman Agus, M.D. "Tumor Lysis Syndrome." www.uptodate.com 2007. Ikeda, Alan, M.D. et al. "Tumor Lysis Syndrome." www.emedicine.com. 2006.