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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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domingo, 7 de agosto de 2016

Tumor Lysis Syndrome

emDocs - Augustt 6, 2016 - Authors: Belcher C Rogers R
Edited by: Koyfman A and Long B
"Background/Diagnosis
Tumor lysis syndrome (TLS) is an oncologic emergency with a constellation of laboratory findings that result from the lysis of cancer cells. This is typically seen in hematologic cancers, but can be seen more rarely in solid tumor diseases. TLS can occurspontaneously in cancers with high proliferative rates or more commonly following chemotherapy initiation of large burden cancers as tumor cells are lysed. This is most likely to occur in acute leukemia and in high-grade lymphomas. As mentioned above, it can be seen rarely in solid tumors such as breast cancer and small cell cancers that respond rapidly to chemotherapy...
TLS is characterized by the following laboratory findings :
  • Hyperkalemia
  • Hyperphosphatemia
  • Hyperuricemia (from the release/breakdown of intracellular nucleic acids)
  • Hypocalcemia (secondary to calcium-phosphate creation
Summary
TLS is an oncological emergency and requires recognition by the emergency provider. A history or new diagnosis of hematological malignancy or recent initiation of chemotherapy should raise suspicion. Laboratory abnormalities from lysis of cells include hyperkalemia, hyperphosphatemia, elevated uric acid levels, and hypocalcemia. Treatment goals involve managing hyperkalemia and symptomatic hypocalcemia, high volume intravenous fluids, decreasing uric acid levels and production through use of rasburicase and allopurinol, and determining the need for RRT. All patients with TLS should be admitted to a highly monitored telemetry or ICU unit as indicated and consultation with nephrology and oncology should be made early in their stay."