CURRENT Essentials of Critical Care.pdf

282 Current Essentials of Critical Care■■■Tumor Lysis SyndromeEssentials of Diagnosis• Recent administration of chemotherapy for treatment of arapidly proliferating malignancy with massive destruction ofneoplastic cells; described in Burkitt lymphoma and some leukemiaswithout precipitating chemotherapy• Lysis of cells leads to hyperkalemia, hyperphosphatemia, hyperuricemia• Hyperphosphatemia associated with hypocalcemia• Hyperuricemia can cause uric acid nephropathy, renal failure• Symptoms related to metabolic and electrolyte changes• Complications: electrocardiographic changes, cardiac arrhythmias,tetany, convulsions, oliguria, muscle cramps, lethargyDifferential Diagnosis• Burkitt lymphoma• Acute lymphocytic leukemia• Chronic lymphocytic leukemia• Solid tumors• Spontaneous necrosis of malignanciesTreatment• Aggressive volume resuscitation• Prevention of hyperuricemia with allopurinol before administrationof chemotherapy• Appropriate treatment for hyperkalemia and hyperphosphatemia• Alkalinization of urine (pH 7.0–7.5) while serum uric acid levelsare elevated• Hemodialysis for life-threatening electrolyte abnormalities andrenal failure■ PearlHigh leukocyte and platelet counts may cause pseudohyperkalemiadue to lysis of these cells after blood collection. No electrocardiographicabnormalities will be seen, and plasma instead of serumpotassium should be followed.ReferenceGobel BH: Management of tumor lysis syndrome: prevention and treatment.Semin Oncol Nurs 2002;18:12. [PMID: 12184047]