Docstoc

Tumour Lysis Syndrome

Document Sample
Tumour Lysis Syndrome Powered By Docstoc
					Tumour Lysis
 Syndrome
              Dr Todd Fraser
          Intensive Care Unit
        The Geelong Hospital
             The Problem
• Large number of dying cells
• Release of intracellular components into
  extracellular space
• Subsequent complications
             Who gets it?
• Most commonly associated with
  haematological malignancies
• Particularly if considered very sensitive
• Risk increased if :
  – older, younger
  – pre-existing renal impairment
  – pre-existing hyperuricaemia or hypocalaemia
  – large tumour load
            What happens?
• Key players are :
  – urate
  – phosphate
  – calcium
  – potassium
  – lactic acidosis
  – other
• Most significant outcome is renal failure
    Mechanisms of Renal Failure
•   Precipitation of urate in kidneys
•   Precipitation of calcium phosphate
•   Precipitation of xanthine crystals
•   Polyuria and dehydration
•   Toxic metabolites of cells
•   Nephrotoxic drugs
                    Prevention
• 3 tenets
  – Promotion of urine output
     • Hydration
     • Frusemide
  – Reduce Urate load
     • allopurinol
     • urate oxidase
  – Alkalinise urine
     • sodium bicarb
     • ural
                 Diagnosis
•   Clinical Context
•   Collection of metabolic problems
•   Urate crystals in urine
•   Urinary urate: Cr
•   DDx include tumour infiltrate of renal
    parenchyma, and drug-related
    rhabdomyolysis
          Other problems
• Hypocalcaemia
  – Intravenous Ca
  – Aluminium hydroxide
 Possible Indications for CVVHD
• Usual
• Unresponsive hyperuricaemia or
  hyperphosphataemia
• Symptomatic hypocalcaemia in setting of
  hyperphosphataemia
                 Summary
•   Uncommon
•   Life threatening metabolic disorder
•   Prevention is key
•   Alkalinisation is debatable

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:26
posted:12/27/2011
language:English
pages:10