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tumor_lysis

Acute tumour lysis syndrome

see also oncology

common oncological settings:

  • haematological malignancies (acute leukaemias & lymphomas)

summary

  • occurs within 1- 5 days of chemo/XRT of rapidly growing tumours that are extremely sensitive to treatment
  • in general, patients with solid tumours are not at risk
  • risk increased with:
    • large bulk of the tumour
    • hyperuricaemia - prior to Rx
    • renal impairment - prior to Rx

complications: 

  • ARF (kidney provides 1° mech. for K+/uric acid/phosphate)
  • Integrity of renal Fx is critical in determining degree of metabolic derangements
  • cardiac dysrhythmias / sudden death ( hypocalcaemia, hyperkalaemia)
  • neuromuscular symptoms
  • Hyperuricaemia (DNA breakdown)
  • hyperkalaemia (cytosol breakdown)
  • hyperphosphatemia (protein breakdown)
  • hypocalcaemia (2° to hyperphosphatemia)

management:

  • serum uric acid
  • U&E
  • serum calcium, phosphate
  • delay chemo/XRT until metabolic derangements are corrected
    • raised K+ ( ? if >6)
    • raised Uric acid ( ? if >59)
    • raised Cr ( ? if >0.9)
    • raised Phosphate ( ? if > 3.2)
    • volume overload
    • symptomatic hypocalcaemia

prognosis

  • good in absence of renal failure
  • if renal failure + hemodialysis is required > 5 days, prognosis is grave
tumor_lysis.txt · Last modified: 2008/09/30 21:59 (external edit)