Tumour Lysis Syndrome

E88.3

DESCRIPTION

Rapid destruction of malignant cells can result in the release of cellular breakdown products and intracellular ions, causing potentially lethal metabolic derangements including acute renal failure.

Commonly seen in cancers with rapidly growing tumours and high tumour burdens, particularly acute leukaemias, chronic myeloid leukaemia and high-grade lymphoma, generally following chemotherapy

Presentation: (Cairo-Bishop definition)

  • azotaemia
  • acidosis
  • hyperphosphataemia >1.45 mmol/L
  • hyperkalaemia >6.0 mmol/L
  • hypocalcaemia <1.75 mmol/L
  • uric acid >0.476 mmol/L

GENERAL MEASURES

There is an increased risk of arrhythmias.

Monitor urine output.

Monitor urine and electrolytes, creatinine and uric acid levels .

MEDICINE TREATMENT

Fluid Restriction

  • IV hydration 2–3 L/m2/day. The urine output needs to be monitored and maintained within 80–100 mL/m2/hour.
  • Diuretics are not indicated in patients with normal renal and cardiac function; and are contraindicated in patients with hypovolemia.
  • Sodium chloride 0.9%, IV, 1000 mL 6–8 hourly.

If patient is hypernatraemic or fluid overloaded, consult a specialist.

LoEIII [1]

For control of uric acid:

  • Allopurinol, oral, 100 mg 8 hourly.
    • Maximum dose: 300 mg 8 hourly.
    • Adjust dose to 50 mg 8 hourly, if eGFR <20 mL/minute.

LoEIII [2]

Correct electrolyte imbalances:

REFERRAL

Transfer to oncology unit.