What is the treatment for tumor lysis syndrome?
In general, treatment of TLS consists of intensive hydration, stimulation of diuresis, and, more specifically, in the use of allopurinol and rasburicase.
How does hydration prevent tumor lysis syndrome?
Volume depletion is a major risk factor for tumor lysis syndrome and must be corrected vigorously. Aggressive IV hydration not only helps to correct electrolyte disturbances by diluting extracellular fluid, it also increases intravascular volume.
Why is hydration important in tumor lysis?
All patients who are at risk for the tumor lysis syndrome should receive intravenous hydration to rapidly improve renal perfusion and glomerular filtration and to minimize acidosis (which lowers urine pH and promotes the precipitation of uric acid crystals) and oliguria (an ominous sign).
Which of the following is a key strategy in the prevention of tumor lysis syndrome?
Aggressive I.V. hydration is the key prevention strategy for all patients at low, intermediate, or high risk for TLS.
Why is allopurinol used in tumor lysis syndrome?
Medications can be adjusted after the start of chemotherapy in response to the level of tumor lysis and/or metabolic disturbances. Allopurinol, a xanthine oxidase inhibitor, reduces the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure.
What are signs of TLS?
Symptoms of TLS include:
- nausea.
- vomiting.
- diarrhea.
- muscle cramps or twitches.
- weakness.
- numbness or tingling.
- fatigue.
- decreased urination.
How does allopurinol prevent TLS?
Once renal failure develops, renal function usually is not restored until uric acid levels are brought down to less than 10 mg/dL. Allopurinol. Allopurinol is a key agent in the management of TLS. Allopurinol acts by competitively inhibiting xanthine oxidase, thereby preventing the conversion of xanthine to uric acid.
How does allopurinol prevent tumor lysis syndrome?
What nursing intervention will help prevent complications from tumor lysis syndrome that may occur during chemotherapy?
Nursing interventions should include monitoring of urine output and alkalinization, when sodium bicarbonate is used. Any decrease in output should be reported; diuretics should be given and/or intravenous fluids should be adjusted accordingly.
Why is LDH elevated in tumor lysis syndrome?
An increase in lactate dehydrogenase (LDH) is typically seen in patients with TLS, probably because of anaerobic glucose metabolism. However, the elevation of LDH is not included in the laboratory definition of LDH and it is important to note that LDH is a very sensitive but quite nonspecific marker for TLS.
How does allopurinol help with TLS?
Allopurinol. Allopurinol is a key agent in the management of TLS. Allopurinol acts by competitively inhibiting xanthine oxidase, thereby preventing the conversion of xanthine to uric acid. When used for treatment, allopurinol is used in dosages similar to prophylactic dosages.
Is dialysis necessary in acute tumor lysis syndrome?
Tumor lysis syndrome (TLS) is a life threatening emergency due to destruction and massive release of intracellular metabolites from cancer cells often resulting in acute kidney injury (AKI), sometimes severe enough to require dialysis (AKI-D). The impact of dialysis requirement in AKI has not been explored.
How is tumor lysis syndrome treated in the intensive care unit?
Established tumor lysis syndrome should be treated in the intensive care unit by aggressive hydration, possible use of loop diuretics, possible use of phosphate binders, use of uric acid lowering agents and dialysis in refractory cases.
What are the indications for renal dialysis for patients with TLS?
Intractable fluid overload, hyperkalaemia, hyperuricaemia, hyperphosphataemia or hypocalcaemia are indications for renal dialysis. (Grade 1A) Peritoneal dialysis (PD) is not recommended for the treatment of TLS. (Grade 1C)
What are the diagnostic criteria for tumor lysis syndrome?
Criteria for Classification of Clinical Tumor Lysis Syndrome Hyperuricemia Uric acid >8.0 mg/dl (475.8 μmol/liter) in adults or above the upper limit of the normal range for age in children Hyperphosphatemia Phosphorus >4.5 mg/dl (1.5 mmol/liter) in adults or >6.5 mg/dl (2.1 mmol/liter) in children