Tumor lysis syndrome history and symptoms: Difference between revisions
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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> | 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> | ||
* [[Tetany (medical sign)| | * [[Tetany (medical sign)|Tetany]] | ||
* [[Seizure]] | * [[Seizure]] | ||
* Mental retardation / [[dementia]] | * Mental retardation / [[dementia]] | ||
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*[[Diarrhea]] | *[[Diarrhea]] | ||
*[[Oliguria]] | *[[Oliguria]] | ||
'''[[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. | '''[[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. | ||
Revision as of 13:46, 22 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Symptoms of tumor lysis syndrome include nausea, vomiting, diarrhea, oliguria, confusion, delirium, and seizure.
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
- cardiac conduction abnormalities (can be fatal)
Hyperphosphatemia. Like potassium, phosphates are also predominantly intracellular. Hyperphosphatemia causes acute renal failure in tumor lysis syndrome, because of deposition of calcium phosphate crystals in the renal parenchyma.
Hypocalcemia. Because of the hyperphosphatemia, calcium is precipitated to form calcium phosphate, leading to hypocalcemia. Symptoms of hypocalcemia include (but are not limited to):
Symptoms of tumor lysis syndrome include:[1]
- Tetany
- Seizure
- Mental retardation / dementia
- Parkinsonian (extrapyramidal) movement disorders
- Papilledema
- Emotional instability / agitation / anxiety
- Delirium
- Hallucinations
- Myopathy
- Nausea
- Vomiting
- Diarrhea
- Oliguria
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.