Guidelines for Complications of Cancer Treatment Vol VIII Part B

hydration, and the administration of phosphate binders. Forsevere hyperphosphatemia, hemodialysis, peritoneal dialysis,or continuous venovenous hemofiltration should be used (levelof evidence: V; grade of recommendation: D).Aluminum hydroxide 50 to 150 mg/kg/d is administered individed doses orally or nasogastrically every 6 hours. Its useshould be limited to 1 to 2 days to avoid cumulative aluminumtoxicity. Because pediatric patients might find the taste ofaluminum hydroxide objectionable, other phosphate binders,such as calcium carbonate (eg, low calcium levels), sevelamerhydroxide, and lanthanum carbonate may alternatively be used.Calcium carbonate should not be used in patients with elevatedcalcium levels. Phosphate clearance has been found to be betterwith hemodialysis as compared with continuous venovenoushemofiltration or peritoneal dialysis. The aboverecommendations are valid for adult patients (level ofevidence: V; grade of recommendation: D).Management of HyperkalemiaIn pediatric patients, oral and IV sources of potassium shouldbe eliminated as long as the risk of TLS exists (Table 6).Immediate intervention is indicated if serum potassium isgreater than 7.0 to 7.5 mEq/L or the ECG shows widening ofQRS complex. For asymptomatic patients, the standardtreatment is sodium polystyrene sulfonate 1 g/kg administeredorally or rectally (avoid this route in neutropenic patients).For symptomatic patients, more intense intervention isrecommended, such as rapid-acting insulin (0.1 U/kgadministered IV) and glucose infusion (25% dextrose 2 mL/kg).Sodium bicarbonate (1 to 2 mEq/kg administered via IVpush) can be given to induce influx of potassium into cells.Calcium gluconate (100 to 200 mg/kg/dose) via slow infusionwith ECG monitoring for bradycardia can be given fortreatment of life-threatening arrhythmias. However, sodium427