Tumor lysis syndrome medical therapy: Difference between revisions
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:*[[Hyperphosphataemia]]: treatment should be initiated if [[phosphorus]] levels are ≥2·1 mmol/l | :*[[Hyperphosphataemia]]: treatment should be initiated if [[phosphorus]] levels are ≥2·1 mmol/l | ||
::*Avoid intra venous phosphate | ::*Avoid intra venous phosphate | ||
::*Aluminium hydroxide (15 ml q6h) | ::*Aluminium hydroxide (15 ml q6h). Poorly tolerated | ||
:*[[Hypocalcemia]]: treatment should be initiated if [[calcium]] levels are ≤1·75 mmol/l | :*[[Hypocalcemia]]: treatment should be initiated if [[calcium]] levels are ≤1·75 mmol/l | ||
::*Asymptomatic: not treatment needed | ::*Asymptomatic: not treatment needed | ||
::*Symptomatic: [[calcium gluconate]] (50–100 mg/kg IV) | ::*Symptomatic: [[calcium gluconate]] (50–100 mg/kg IV) | ||
::*Cardiac monitoring is recommended if calcium level drops below ≤1.75mmol/l | |||
:*[[Hyperkalemia]]: | :*[[Hyperkalemia]]: | ||
::*Asymptomatic (≥6·0 mmol/l): avoid potassium administration, ECG, and sodium polystyrene sulphonate | ::*Asymptomatic (≥6·0 mmol/l): avoid potassium administration, ECG, and sodium polystyrene sulphonate | ||
| Line 30: | Line 31: | ||
:*[[Hyperuricemia]]: | :*[[Hyperuricemia]]: | ||
::*Allopurinol (10 mg/kg/d divided q8 h), reduce the dose by 50% in renal failure | ::*Allopurinol (10 mg/kg/d divided q8 h), reduce the dose by 50% in renal failure | ||
::*Rasburicase ( 0·05–0·20 mg/kg IV over 30 min) | ::*Rasburicase (0·05–0·20 mg/kg IV over 30 min). The duration of treatment depends on the clinical response. | ||
Revision as of 14:22, 30 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
Tumor lysis syndrome is a medical emergency and requires prompt treatment. [1]
Medical Therapy
The treatment of tumor lysis syndrome is a multidisciplinary effort between nephrologist, hematologist, and intensivist.[2][3]
- Intravenous fluids:
- Aggressive hydration (3 l/m2/d)
- Maintain urine output 4ml/kg/h for infants and 100ml/m2/h for adults
- Avoid adding potassium in hydration fluids
- Fluid loss should be measured, such as vomiting and diarrhea
- Elderly, infants, and patients with cardiac disease are at high risk of developing hypervolemia
- Mannitol (0·5 mg/kg)
- Furosemide (0·5–1·0 mg/kg)
- Note: Alkalization of urine is not recommended to increase the excretion of uric acid (the use of sodium bicarbonate is controversial).[4]
- Electrolytes disturbance:
- Hyperphosphataemia: treatment should be initiated if phosphorus levels are ≥2·1 mmol/l
- Avoid intra venous phosphate
- Aluminium hydroxide (15 ml q6h). Poorly tolerated
- Hypocalcemia: treatment should be initiated if calcium levels are ≤1·75 mmol/l
- Asymptomatic: not treatment needed
- Symptomatic: calcium gluconate (50–100 mg/kg IV)
- Cardiac monitoring is recommended if calcium level drops below ≤1.75mmol/l
- Asymptomatic (≥6·0 mmol/l): avoid potassium administration, ECG, and sodium polystyrene sulphonate
- Symptomatic (>7·0 mmol/l): add calcium gluconate (100–200 mg/kg) IV and/or regular insulin (0·1 unit/kg IV) + D25 (2 ml/kg) IV, and dialysis
- Allopurinol (10 mg/kg/d divided q8 h), reduce the dose by 50% in renal failure
- Rasburicase (0·05–0·20 mg/kg IV over 30 min). The duration of treatment depends on the clinical response.
- Acute renal failure prior to chemotherapy:
- Acute renal failure after chemotherapy:
- The major cause of acute renal failure in this setting is hyperphosphatemia, and the main therapeutic means is hemodialysis. Forms of hemodialysis used include continuous arteriovenous hemodialysis (CAVHD), continuous venovenous hemofiltration (CVVH), or continuous venovenous hemodialysis (CVVHD).
References
- ↑ Jeha S (2001). "Tumor lysis syndrome". Semin Hematol. 38 (4 Suppl 10): 4–8. PMID 11694945.
- ↑ 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.
- ↑ Jones, Gail L; Will, Andrew; Jackson, Graham H; Webb, Nicholas J A; Rule, Simon (2015). "Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology". British Journal of Haematology. 169 (5): 661–671. doi:10.1111/bjh.13403. ISSN 0007-1048.
- ↑ Ten Harkel AD, Kist-Van Holthe JE, Van Weel M, Van der Vorst MM (1998). "Alkalinization and the tumor lysis syndrome". Med Pediatr Oncol. 31 (1): 27–8. PMID 9607427.