tumor lysis syndrome

• patho

  • constellation of metabolic disturbances occurring when large numbers of neoplastic cell lysis from chemo or radiation
  • leads to release of intracellular electrolytes and metabolic byproducts
  • reaction to cancer treatment causing lymph nodes to explode and release byproducts into circulation
• causes

  • complication of cancer treatment like chemo and/or radiation
  • most common in lymphoma, leukemia or multiple metastatic conditions
• hyperuricemia

  • greater than 8
  • renal failure, AKI
  • treat with dialysis and hydration
• hyperkalemia

  • greater than 5
  • dysrhythmias- peaked t waves, wide qrs, frequent pvc, leading to vfib/vtach/asystole
  • treat
  • regular insulin and glucose IV to push potassium into cell and maintain blood sugar
  • sodium bicarb to buffer and regulate acidosis and aids in potassium shift
  • calcium gluconate to shift potassium
  • kayexhalate liquid PO or ETT to bind potassium to stool and excrete. severe diarrhea
• hyperphosphatemia

  • greater than 4.5
  • tetany, muscle cramps, seizures
  • positive ckvostek and trousseau
  • treat with dialysis and hydration
• hypocalcemia

  • less than 8
  • tetany, renal failure
  • positive ckvostek and trosseau
  • treat with calcium gluconate to provide clacium
• management

  • large volume IV fluids with diuretics- furosemide/bumex for renal failure and dilute electrolytes
  • rasburicase to decrease uric acid
  • allopurinol to prevent formation of uric acid. also used prophylactically for patients at risk
  • frequent labs
  • I/O catheter
  • thorough assessment q2
  • seizure precautions
  • cannot continue cancer treatment