Acute tumor lysis syndrome (Regulatory)

Patho/etiology

Lysis of tumor cells releases cell content

rapid increase in serum levels of electrolytes (K, phosphate, an Ca) and uric acid

(frequently) treatment of large or rapid growing cancer cells (Leukemia, lymphoma, small cell lung cancer) by radiation, bio, or chemotherapy causes the destruction of cells

electrolyte and pH disturbance causes end organ damage in myocardium, kidneys and CNS

Labs/ Diagnostics

Electrolytes

urinalysis

Creatinine

ECG

Diagnosed when 1 or more of 3 conditions occur 3 days prior to or 7 days after cytotoxic cancer treatment: Kidney injury (creatinine 150% upper limit), dysrhythmia, and seizure.

S&S

Complications

Renal damage

Collaborative treatment

Allopurinol (inhibits conversion of nucleic acid to uric acid)

loop diuretics

Aggressive hydration before and after cytotoxic therapy

bicarb (raises pH to prevent kidney damage)

kayexalate or insulin/ dextrose to reduce serum K+

phosphate binding gel

Fatigue

weakness

altered mental status

siezure

dysrhythmias

cardiac arrest

N/V/A/D

abd cramping

flank pain

oliguria/ anuria

acidic urine

gout

siezure

impaired mentation

interruption of treatment

Risk factors

Cytotoxic cancer treatment

poor hydration

renal impairment

dialysis