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Definition
Tumor lysis syndrome (TLS) is characterized
by an array of metabolic imbalances associated
with the rapid destruction of a large number of
WBCs. that develop in patients with cancer af-
ter the onset of chemotherapy treatment or,
less often, prior to treatment.
TLS has been reported most often in patients’
suffering from malignancies with a high rate of
proliferation, especially cancers with a high re-
sponse rate and rapid responses to cytotoxic
therapy.
These include aggressive non-Hodgkin lympho-
ma, notably diffuse large B-cell lymphoma, lym-
phoblastic lymphoma, and Burkitt lymphoma; Clinical Features
acute and chronic leukemias; and, less often, Hyperuricemia
bulky solid tumors.
GI: Nausea, Vomiting, Diarrhea, Anorexia
Occurs 24-48 hours into treatment
Renal: Edema, Flank Pain, Hematuria, Oliguria, Cloudy, sediment
May persist up to one week
in urine, Anuria, Azotemia, Crystalluria
Etiology & Risk Factors
Neuromuscular: Lethargy, Goutlike Symptoms
Following the administration of therapy, malig-
nant cells are destroyed rapidly releasing into Treatment Modalities
circulation intracellular components. Prevent TLS by recognizing the patient population who is at risk
high tumor burden and initiating prophylactic measures before initiation of antineo-
plastic therapy.
high rate of proliferation
Hydration should begin 24 to 48 hours before treatment and con-
and disease that is highly responsive to
therapy tinue for at least 72 hours after treatment. This is to maintain a
urinary output of 100 ml/hr.
Bulky tumors ( > 8-10cm)
Diuretics – to promote the excretion of phosphate and uric acid.
Pre-existing hyperuricemia
Allopurinol – prevents uric acid formation.
≥ 60 years old
Rasburicase – used in treatment and prevention of chemotherapy
-induced hyperuricemia.
Rasburicase lowers preexisting uric acid.
Sodium Bicarbonate – used to maintain an alkaline urine (pH>7)
to prevent uric acid crystallization (50 to 100 mEq/L fluid or 50
mEq by IV bolus).
Acetazolamide – used to decrease bicarbonate resorption in the
kidney so that it is excreted in the urine where it enhances alka-
linization.
Nursing Considerations
Careful monitoring of lab values. (uric acid
levels)
Assess medications for those that contain
phosphate and discuss discontinuation with
physician.
Assess patient for signs and symptoms of
TLS (Hyperuricemia).
Administer diuretics, sodium bicarbonate, as
appropriate.
Monitor I/O and notify physician if urinary
output is less than 7.0 with sodium bicar-
bonate.
Prepare the patient and family for dialysis if
other measures are not effective.
Be prepared to transfer patient to the ICU for
hemodynamic monitoring.
Assess the patient for jugular venous disten-
tion and peripheral edema.