Hematology and Oncology Book

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Tumor Lysis Syndrome

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  1. Definition
    1. Acute tumor cell lysis post-Chemotherapy and radiation
  2. Pathophysiology
    1. Massive tumor lysis releases breakdown products
      1. Uric Acid
      2. Phosphates
      3. Calcium
      4. Potassium
    2. Tumor breakdown products overwhelm excretion mechanism
    3. Onset within 5 days of Chemotherapy or radiation
  3. Causes: Most common associated tumors
    1. Rapidly growing tumors
      1. Acute Leukemia
      2. Lymphoma
  4. Labs: Chemistry panel
    1. Renal Function tests: Acute Renal Failure
      1. Blood Urea Nitrogen increased
      2. Serum Creatinine increased
    2. Serum bicarbonate or ABG: Metabolic Acidosis
    3. Serum phosphate: Hyperphosphatemia
    4. Serum Potassium: Hyperkalemia
    5. Serum Calcium: Hypocalcemia
  5. Management
    1. Hospitalization
    2. Intravenous fluids
    3. Uric Acid management
      1. Allopurinol
      2. Urate oxidase (uricase)
    4. Alkalinize urine
    5. Hemodialysis

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