Regulation: Acute Tumor Lysis Syndrome (ATLS) - Coggle Diagram
Regulation: Acute Tumor Lysis Syndrome (ATLS)
Serum electrolytes - high potassium & phosphorus,
ABGs showing decreased blood pH and bicarbonate -- metabolic acidosis
Increased BUN, Cr
ECG for dysrhythmias r/t hyperkalemia
Etiology: chemotherapy treatment
Cellular lysis is the desired effect of cancer treatment to manage abnormal cells. Large amounts of nucleic acids, electrolytes, and debris are released from the dead cells at the tumor site following cytotoxic therapy.
Abundance of serum potassium from intracellular space causes rapid development of hyperkalemia, contributing to electrolyte imbalances that damage heart and kidneys
DNA components are broken down into phosphorus and purines/uric acid, causing hyperphosphatemia and hyperuricemia.
Excess phosphorus binds to serum calcium, forming calcium phosphate. Body is unable to utilize calcium in this form, hypocalcemia develops, and body attempts to compensates with increased bone resorption.
Renal workload increases to stabilize calcium-phosphorus imbalance by excreting excess phosphorus. Uric acid collects and crystalizes in renal tubules. These factors precipitate acute renal failure.
Influx of lactic acid decreases blood pH and causes metabolic acidosis, further contributing to renal damage
Low GFR, existing renal impairement
Certain types of cancer such as lymphoma & leukemia
Intensive treatment interventions requiring cytotoxic treatment
Decreased LOC, fatigue, memory loss
Altered ECG -- short QT, wide QRS, altered T, dysrhythmia
Blood pressure increases
Oliguria, concentrated acidic urine
Gout from uric acid levels
Tetany, cramps, paresthesia
Cardiac arrest from electrolyte disturbances
Fluid therapy within 24-48 hours of treatment to to increase fluid volume, perfuse the kidneys, and promote excretion of uric acid to maintain electrolyte balance.
Administer Allopurinol to prevent conversion of uric acid
Diuretics to increase urine output
Polystrene sulfonate (Kayexalate) to manage hyperkalemia
Phosphate binding gels to increase fecal phosphorus elimination
Monitor fluid & electrolytes, ABG labs, urine pH and uric acid levels.