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tumor lysis syndrome

Tumor Lysis Syndrome

What is TLS?

  • Oncologic emergency caused by the massive lysis of tumor cells, most frequently after initiation of cytotoxic therapy (chemotherapy, steroids, radiation) but can be spontaneous
  • Who is at risk?
    • “Liquid” malignancies (leukemias, lymphomas)
    • Recent chemotherapy (6-72 hr)
    • High tumor burden, tumors with rapid turnover
    • Pre-existing renal impairment
    • Meds that increase uric acid (aspirin, thiazides, levodopa,methyldopa,caffeine, alcohol)
    • tls 2
  • Complications:
    • Metabolic derangements
    • tls 3
      • Hyperkalemia
      • Hyperuricemia
      • Hyperphosphatemia
      • Hypocalcemia
    • Renal failure
    • Arrhythmia, sudden death
    • Seizure
  • Treatment-
    • Fluids–> increase urinary output, “wash out” crystals in tubules
    • Correct electrolyte abnormalities, may necessitate emergent dialysis
    • Rasburicase dose : 0.2mg/kg (14mg for 70kg pt)
    • Sevelamer phos binder of choice

Sources:
Tumor Lysis Syndrome- Prevention and Treatment. http://www.uptodate.com/contents/tumor-lysis-syndrome-prevention-and-treatment?source=outline_link&view=text&anchor=H21712175#H21712175
British Guidelines for Management of TLS. http://www.bcshguidelines.com/documents/Tumour_Lysis.pdf

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Brian

Kings County Hospital | SUNY Downstate Emergency Medicine Resident -Clinical Monster Webmaster

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Brian

Kings County Hospital | SUNY Downstate Emergency Medicine Resident

-Clinical Monster Webmaster

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