Tumor Lysis Syndrome free essay sample

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 Burkitts 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 gt; 8 · potassium level gt; 6  · phosphorus level gt; 4. 5 · calcium level lt; 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 Trousseaus 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 Hyperkalemia  · caused by intracellular potassium release from tumor lysis  · worsed with a metabolic acidosis  · shortened QT interval, peaked T waves, flattened P waves, prolonged PR interval, wide QRS, deep S wave, sine waves, ventricular arrhythmias, asystole, death  · often the first life-threatening abnormality identified  · treat with restriction of dietary potassium, kayexelate, and IV glucose and insulin  · if K gt; 6. We will write a custom essay sample on Tumor Lysis Syndrome or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page 5, calcium gluconate or calcium carbonate may be given for cardioprotecion Hyperuricemia  · caused by the rapid turnover of nucleic acids uric acid can precipitate in the tubules, medulla, and collecting ducts of the kidney  · elevated levels can lead to nausea/vomiting, arthralgias, and lethargy  · worsened by a metabolic acidosis  · treat with allopurinol  · may treat with rasburicase  · may magnify clinical hypocalcemia  · if prior treatment ineffective, acetazolamide may be used Metabolic Acidosis  · caused by release of endogenous intracellular acids  · elevated anion gap  · decreased serum bicarbonate levels  · decreased uric acid solubility  · increased calcium phosphate solubility Acute Renal Failure  · oligoanuric  · causes volume overload, pulmonary edema precipitated by uric acid crystallization, calcium phosphate crystallization  · if conservative medical management does not correct these abnormalities, emergent dialysis is warranted to prev ent permanent kidney damage The likelihood of developing TLS depends on several factors:  · tumor burden · renal function  · uric acid level · LDH level  · tumor sensitivity to treatment · elderly age Pre-treatment care:  · CBC · LDH level  · CMP · uric acid level  · ionized calcium · hydration  ·possible pre-alkalinization of the urine Post-treatment care:  · close monitoring for 48-72 hours after treatment continuous cardiac monitoring  · hydration  · BUNs TID  · measurement of urine pH TID  · dialysis if indicated 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. Harrisons 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.