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🌱來自: Tumor Lysis Syndrome - Fast Facts

Treatment of Tumor Lysis Syndrome

• Avoid IV contrast and NSAIDs; treat hyperK, hyperPO4, and only symptomatic hypoCa • Allopurinol + aggressive IV hydration ± diuretics to ↑ UOP for goal 80–100 cc/h • Rasburicase (0.1–0.2 mg/kg or 6 mg IV fixed dose) for ↑↑ uric acid esp. in aggressive malig (JCO 2003;21:4402; Acta Haem 2006;115:35). Avoid in G6PD def (hemolytic anemia). Consider G6PD testing in Jehovah’s Witnesses especially if Black (12% prevalence). • Hemodialysis may be necessary; early renal consultation for renal insufficiency or ARF

• consider intensive care unit (ICU) transfer, depending on clinical status and degree of metabolic derangement (Note: TLS implies a highly responsive tumor and initial response to therapy.)

• lab tests every 4 to 6 hours and treatment of electrolyte abnormalities

• cardiac monitoring

• intravenous fluids (IVF)

• rasburicase for significant hyperuricemia, particularly if renal dysfunction is a concern

• dialysis as a last resort

The following flowchart is helpful for the initial assessment and management of TLS:

(Source: The Tumor Lysis Syndrome. N Engl J Med 2011.)

Figure: