Tumor lysis syndrome medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tumor lysis syndrome}} | {{Tumor lysis syndrome}} | ||
{{CMG}} | {{CMG}} {{AE}} {{MJK}} | ||
==Overview== | ==Overview== | ||
Tumor lysis syndrome is a medical emergency and requires prompt treatment. | |||
<ref name="pmid11694945">{{cite journal| author=Jeha S| title=Tumor lysis syndrome. | journal=Semin Hematol | year= 2001 | volume= 38 | issue= 4 Suppl 10 | pages= 4-8 | pmid=11694945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11694945 }} </ref> | |||
==Medical Therapy== | ==Medical Therapy== | ||
*Intra venous fluids: | |||
:*Aggressive hydration (3 l/m2/d) | |||
:*[[Diuretics]]: | |||
::*[[Mannitol]] (0·5 mg/kg) | |||
::*[[Furosemide]] (0·5–1·0 mg/kg) | |||
:*Alkalization of urine is recommended to increase the excretion of uric acid (the use of sodium bicarbonate is controversial)<ref name="pmid9607427">{{cite journal| author=Ten Harkel AD, Kist-Van Holthe JE, Van Weel M, Van der Vorst MM| title=Alkalinization and the tumor lysis syndrome. | journal=Med Pediatr Oncol | year= 1998 | volume= 31 | issue= 1 | pages= 27-8 | pmid=9607427 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9607427 }} </ref> | |||
*Electrolytes disturbance: | |||
:*[[Hyperphosphataemia]]: treatment should be initiated if [[phosphorus]] levels are ≥2·1 mmol/l. | |||
::*Avoid intra venous phosphate | |||
::*Aluminium hydroxide (15 ml q6h) | |||
:*[[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) | |||
:*[[Hyperkalemia]]: | |||
::*Asymptomatic (≥6·0 mmol/l): avoid potassium administration, ECG, 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]] | |||
:*[[Hyperuricemia]]: | |||
::*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) | |||
*'''Acute renal failure prior to chemotherapy'''. Since the major cause of acute renal failure in this setting is uric acid build-up, therapy consists of [[rasburicase]] to wash out excessive uric acid crystals as well as a [[loop diuretic]] and fluids. Sodium bicarbonate should not be given at this time. If the patient does not respond, [[hemodialysis]] may be instituted, which is very efficient in removing uric acid, with plasma uric acid levels falling about 50% with each six hour treatment. | *'''Acute renal failure prior to chemotherapy'''. Since the major cause of acute renal failure in this setting is uric acid build-up, therapy consists of [[rasburicase]] to wash out excessive uric acid crystals as well as a [[loop diuretic]] and fluids. Sodium bicarbonate should not be given at this time. If the patient does not respond, [[hemodialysis]] may be instituted, which is very efficient in removing uric acid, with plasma uric acid levels falling about 50% with each six hour treatment. | ||
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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
- Intra venous fluids:
- Aggressive hydration (3 l/m2/d)
- Diuretics:
- Mannitol (0·5 mg/kg)
- Furosemide (0·5–1·0 mg/kg)
- Alkalization of urine is recommended to increase the excretion of uric acid (the use of sodium bicarbonate is controversial)[2]
- Electrolytes disturbance:
- Hyperphosphataemia: treatment should be initiated if phosphorus levels are ≥2·1 mmol/l.
- Avoid intra venous phosphate
- Aluminium hydroxide (15 ml q6h)
- 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)
- Asymptomatic (≥6·0 mmol/l): avoid potassium administration, ECG, 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)
- Acute renal failure prior to chemotherapy. Since the major cause of acute renal failure in this setting is uric acid build-up, therapy consists of rasburicase to wash out excessive uric acid crystals as well as a loop diuretic and fluids. Sodium bicarbonate should not be given at this time. If the patient does not respond, hemodialysis may be instituted, which is very efficient in removing uric acid, with plasma uric acid levels falling about 50% with each six hour treatment.
- 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.
- ↑ 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.