tumor_lysis
Table of Contents
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
- haemodialysis if:
- 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)
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