Oncologic Emergencies tumor lysis syndrome DR Rania Bakery DR

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Oncologic Emergencies tumor lysis syndrome DR Rania Bakery DR Powered By Docstoc
					Oncologic Emergencies tumor
 y     y
lysis syndrome

     DR Rania Bakery
     DR.

     Lecturer of oncol. Clin.
     Pathology.
     Pathology SECI
Tumor Lysis Syndrome
T     L i S d

Patients with rapidly growing tumors and/or
 bulky disease

Risk of rapid lysis of tumor cells and release
 of intracellular contents overwhelming
 kidney’s ability to excrete those products
                                   y p
  Most common with Burkitt’s lymphoma,     ,
    T-cell leukemia/lymphoma, B-cell
    leukemia
Tumor Lysis Syndrome
T     L i S d

Can occur at presentation, but more
            l ft     t t f
 common early after start of
 chemotherapy

                           life-
Risk of renal failure and life
 threatening electrolyte disturbances
Consequences of tumor lysis
   d
syndrome

Hyperkalemia     weakness, dysrhythmias
Hyperphosphatemia  hypocalcemia, renal
                      failure
Hypocalcemia     tetany, mental status
                   changes,
                   changes seizures
  yp
Hyperuricemia                 p     p    y
                   “uric acid nephropathy” =
                   oliguria, renal failure
“The
“ h best treatment is prevention”
Hydration
                   2 3
 Fluid intake = 2-3 L/m2/day enhances uric
   acid excretion, phosphate excretion
Urine alkalinization - add NaHCO3 to IVF
 Uric acid more soluble at urine pH = 7.0 vs
   50
   5.0
 Goal of urine specific gravity  1.015 and
    H 7.0 7.5
   pH 7 0 - 7 5
                 yp
 Caution - - hypoxanthine and Ca-PO4
   stones possible if urine pH > 7.5
                       Dialysis
Prevention
P     ti

Decrease production              Xanthine   Hypoxanthine
 of uric acid
  Allopurinol - - inhibits                   xanthine
   xanthine oxidase                             id
                                              oxidase
     300 mg/m2/day divided
      tid P.O./I.V.
     Dose reduction in renal          U i acid
                                       Uric id
      insufficiency
     Long time standard Rx
                                              ll       l
                                             Allopurinol
Urate oxidase            Dialysis



                                  mbi     t  t
                            Recombinant urate
                            R
Present in other
                             oxidase
 mammalian sp c s
 mamma an species
                             ( sb i s ) m
                             (rasburicase) more
Catalyzes conversion        effective than
 of uric acid to              ll pu in l
                             allopurinol in
 allantoin                   prevention and
  Allantoin more            treatment of  f
   soluble, easily           hyperuricemia
               y    y
   excreted by kidneys
                                G ld
                                Goldman, 2001
Urine alkalinization
                            Contraindicated with
 unnecessary if used
                             G-6-PD d f
                             G P deficiency,
                             asthma
Dialysis for Tumor Lysis
Syndrome
S d

Indications: oliguria, hyperkalemia,
    t i hyperphosphatemia,
 azotemia, h       h    h t i
 refractory hyperuricemia

Hemodialysis or continuous venovenous
 hemofiltration with dialysis most
  ff   i
 effective