Tumor lysis syndrome primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Prevention

Patients about to receive chemotherapy for a cancer with high cell turnover rate, especially lymphomas and leukemias, should receive prophylactic oral or IV allopurinol (a xanthine oxidase inhibitor, which inhibits uric acid production) as well as adequate IV hydration to maintain a high urine output (> 2.5 L/day). Rasburicase (Uricase) is an alternative to allopurinol and is reserved for patients who are high-risk in developing TLS. It is a synthetic urate oxidase enzyme and acts by degrading uric acid. Alkalinization of the urine with acetazolamide or sodium bicarbonate is controversial. Routine alkalinization of urine above pH of 7.0 is not recommended. Alkalinization is also not required if uricase is used.