The document discusses tumor lysis syndrome (TLS), a potentially fatal metabolic complication that can result from spontaneous or treatment-related tumor cell death. TLS is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. It defines TLS and outlines its frequency, etiology, risk factors, pathophysiology, prevention, diagnosis, and management, emphasizing the importance of identifying high-risk patients and initiating preventive treatment to avoid complications like acute renal failure.

1. 主講者 : 黃馨瑩 指導者 : 李偉政 96-09-27

12. Pathophysiology 96-09-27

19. Mechanisms of action 96-09-27

21. Rampello E et al. (2006) The management of tumor lysis syndrome Nat Clin Pract Oncol 3 : 438 – 447 doi:10.1038/ncponc0581 Table 2 Solubility of purine analogs and calcium phosphate at pH 5.0 and 7.0 96-09-27

23. Diagnostic evaluation 96-09-27 History of malignancy Symptom and sign of metabolic abnormality and complications prior to or after chemotherapy Management: Hydration and diuretics Correct electrolyte imbalance Hemodialysis if needed Urine alkalization: controversial. TLS?? 4 “H” Presence of risk factor Work up: Laboratory: electrolyte, LDH, RFT, urine pH, EKG Image studies Others: Monitor I/O, fluid status, histologic findings

26. Rampello E et al. (2006) The management of tumor lysis syndrome Nat Clin Pract Oncol 3 : 438 – 447 doi:10.1038/ncponc0581 Table 3 Tumor lysis syndrome management 96-09-27

31. Mechanism of Action Recommended dosing: 0.15 or 0.20 mg/kg/d for 5 d 96-09-27

32. Management 25~50gm Q6h Kayexalate Exchange resins Insulin + dextrose 1meq/kg IV 50~100meq/L IVF Sodium bicarbonate Intracellular potassium transporters Hyperkalemia 10ml Q2h for 12x/day Aluminum hydroxide Phosphate-binding agents Hyperphosphatemia 10% calcium chloride: K + ↑: 2~4mg/kg Q6~8h prn K + ↓: 0.5~1gm Q1~3d Calcium gluconate; Calcium chloride Mineral Hypocalcemia 0.15~0.2mg/kg/d for 5~7 d Rasburicase Uric acid oxidizers Prophylaxis: 200~600mg/dl Tx: 600~900mg/dl Allopurinol Xanthine oxidase inhibitors Hyperuricemia Dose Drug name Drug category Metabolic abnormality