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{{Tumor lysis syndrome}}
{{Tumor lysis syndrome}}
{{CMG}} {{AE}} {{MJK}}
{{CMG}} {{AE}} {{MJK}}  {{N.F}}
==Overview==
==Overview==
Symptoms of tumor lysis syndrome include [[nausea]], [[vomiting]], [[diarrhea]], [[oliguria]], [[confusion]], [[delirium]], and [[seizure]].
Symptoms of tumor lysis syndrome include [[nausea]], [[vomiting]], [[diarrhea]], [[oliguria]], [[confusion]], [[delirium]], and [[seizure]].


==History and Symptoms==
==History and Symptoms==
'''[[Hyperkalemia]]'''. [[Potassium]] is mainly an [[intracellular]] [[ion]]. High turnover of tumor cells leads to spill of potassium into the blood. Symptoms usually do not manifest until levels are high (> 7mmol/dL) [normal 3.5-5.0 mmol/dL] and they include


* severe muscle weakness or paralysis
=== History ===
* [[heart|cardiac]] conduction abnormalities (can be fatal)
Patients with tumor lysis syndrome may have a positive history of:<ref name="cancer.ca" />
*[[Chemotherapy]] use
*[[Renal dysfunction]]
*[[Malignancy]]


'''[[Hyperphosphatemia]]'''. Like potassium, [[phosphate]]s are also predominantly intracellular. Hyperphosphatemia causes acute [[kidney|renal]] failure in tumor lysis syndrome, because of deposition of [[calcium phosphate]] crystals in the renal [[parenchyma]].
=== Common Symptoms: ===
 
Symptoms of tumor lysis syndrome include:<ref name="cancer.ca">Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/tumour-lysis-syndrome/?region=ab#symptoms</ref><ref name="pmid15384972">{{cite journal| author=Cairo MS, Bishop M| title=Tumour lysis syndrome: new therapeutic strategies and classification. | journal=Br J Haematol | year= 2004 | volume= 127 | issue= 1 | pages= 3-11 | pmid=15384972 | doi=10.1111/j.1365-2141.2004.05094.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15384972}}</ref>
'''[[Hypocalcemia]]'''. Because of the hyperphosphatemia, [[calcium]] is precipitated to form calcium phosphate, leading to hypocalcemia. Symptoms of hypocalcemia include (but are not limited to):
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
 
| valign="top" |
 
|+
Symptoms of tumor lysis syndrome include:<ref name="cancer.ca">Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/tumour-lysis-syndrome/?region=ab#symptoms</ref>
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Electrolytes disturbance}}
* [[Tetany (medical sign)|Tetany]]
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Symptoms}}
* [[Seizure]]
|-
* Mental retardation / [[dementia]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
* Parkinsonian (extrapyramidal) movement disorders
[[Hyperphosphatemia]]
* [[Papilledema]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Emotional instability / agitation / anxiety
*[[Delirium]]
*[[Hallucinations]]
*[[Myopathy]]
*[[Nausea]]
*[[Nausea]]
*[[Vomiting]]
*[[Vomiting]]
*[[Diarrhea]]
*[[Diarrhea]]
*[[Oliguria]]
*[[Lethargy]]
 
*[[Seizure]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Hypocalcemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Tetany (medical sign)|Tetany]]
*[[Paresthesias]]
*[[Arrhythmias]]
*[[Hypotension]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Hyperkalemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Nausea]]
*[[Diarrhea]]
*[[Cramps]]
*[[Muscle weakness]]
*[[Parathesia]]
*[[Tachycardia]]
*[[Syncope]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
[[Hyperuricemia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Hematuria]]
*[[Flank pain]]
*[[Hypertension]]
*[[Edema]]
*[[Oliguria]]  
*[[Anuria]]
*[[Somnolence]]
*[[Hallucinations]]
|}


'''[[Hyperuricemia]]'''. [[Uric acid]] is a breakdown product of [[DNA]], converted by [[xanthine oxidase]] from [[xanthine]] and [[hypoxanthine]], which are in turn [[purine]] breakdown products. Uric acid is more toxic to tissues than (hypo)xanthine. Uric acid [[nephropathy]] has been a dominant cause of acute renal failure but with the advent of [[allopurinol]] and uricase treatment, hyperphosphatemia has replaced this as the main cause of acute renal failure. Oddly, [[gout]] is not a feature of tumor lysis syndrome; the high uric acid levels that cause gout probably need to be present for an extended period of time before the putative crystals can develop.
=== Less Common Symptoms: ===
*[[Abdominal pain]]
*[[Abdominal distention]]
*[[Paralysis]]
*[[Syncope]]
*[[Altered mental status]]


==References==
==References==
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[[Category:Blood]]
[[Category:Blood]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 13:24, 1 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2] Nazia Fuad M.D.

Overview

Symptoms of tumor lysis syndrome include nausea, vomiting, diarrhea, oliguria, confusion, delirium, and seizure.

History and Symptoms

History

Patients with tumor lysis syndrome may have a positive history of:[1]

Common Symptoms:

Symptoms of tumor lysis syndrome include:[1][2]

Electrolytes disturbance Symptoms

Hyperphosphatemia

Hypocalcemia

Hyperkalemia

Hyperuricemia

Less Common Symptoms:

References

  1. 1.0 1.1 Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/tumour-lysis-syndrome/?region=ab#symptoms
  2. Cairo MS, Bishop M (2004). "Tumour lysis syndrome: new therapeutic strategies and classification". Br J Haematol. 127 (1): 3–11. doi:10.1111/j.1365-2141.2004.05094.x. PMID 15384972.

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