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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Hematology & Oncology : Tumor Lysis Syndrome

Tumor lysis syndrome occurs secondary to spontaneous or treatment-related tumor necrosis. This results from the acute lysis of tumor cells results in rapid release of K, phosphates and nucleic acids.

This process results in:

  • Hyperkalemia
  • Hyperphosphatemia
  • Hyperuricemia
  • Hypocalcemia
  • Renal failure
  • Multi-organ system failure

Treatment:

Vigorous hydration with 2xmaint

  • No K in IVF
  • Goal UOP >2-3cc/kg/hr
  • Dilute urine will reduce ppt of uric acid
  • Cautiously consider diuretic if UOP is inadequate
  • Alkalinize Urine
  • Uric acid more soluble in alkaline urine
  • Allopurinol (po): < 20kg: 50mg tid, 20-40kg: 100mg tid, > 40kg: 200mg tid
  • Inhibit production of uric acid from xanthine

Labs:

  • Monitor lytes, Mag, Ca, Phos, uric acid and renal function
  • Q4-6 h labs for high risk pts and Q12h for lower risk

Consider dialysis if:

  • Symptomatic HyperK and Hyperphos/ HypoCa
  • Worsening renal function
  • Volume overload


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