Guidelines for Complications of Cancer Treatment Vol VIII Part B

icarbonate and calcium should not be administered throughthe same line (level of evidence: V; grade ofrecommendation: D). Elevated potassium levels should beverified immediately with a second sample to rule out fictitioushyperkalemia from hemolysis during phlebotomy. Patient ECGand cardiac rhythm should be closely followed, along withevaluation of electrolyte levels. The above recommendationsare valid for adult patients (level of evidence: V; grade ofrecommendation: D).Management of HypocalcemiaFor asymptomatic pediatric patients, no intervention isrecommended (Table 6). Symptomatic patients may be treatedwith calcium gluconate 50 to 100 mg/kg IV, administeredslowly with EKG monitoring (Level of evidence: V; gradeof recommendation: D). Care must be taken becauseincreased calcium might increase the risk of calcium phosphateprecipitation in the tissues and consequential obstructiveuropathy. The above recommendations are valid for adultpatients (level of evidence: V; grade of recommendation: D).Monitoring during treatment:Check laboratory and clinical TLS parameters 4 to 6 hoursafter the initial administration of chemotherapy. The TLSparameters consist of levels of uric acid, phosphate, potassium,creatinine, calcium, and LDH, as well as fluid input and urineoutput. For all patients, uric acid levels should be re-evaluated4 hours after administration of rasburicase and every 6 to 12hours thereafter until resolution of TLS, for example, untilnormalization of LDH levels (level of evidence: V; grade ofrecommendation: D).For adult intermediate-risk patients, patients should bemonitored for at least 24 hours after the completion ofchemotherapy. For multiagent chemotherapeutic regimens in428