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