Acute Tumor Lysis Syndrome (ATLS)
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First Things First (assess & treat for the following)
- Definition of tumor lysis
- Rapid release of intracellular ions & products into the peripheral circulation; may be life-threatening
- Most commonly seen after therapy for aggressive hematologic malignancies
- May also occur spontaneously in both hematologic malignancies and kinetically active solid tumors
- Cairo-Bishop definition for diagnosis
- Uric acid ≥8 mg/dL (≥476 µmol/L) or 25% increase from baseline
- Potassium ≥6.0 mEq/L (≥6 mmol/L) or 25% increase from baseline
- Phosphorus ≥6.5 mg/dL (≥2.1 mmol/L) or 25% increase from baseline
- Calcium ≤7 mg/dL (≤1.75 mmol/L) or 25% decrease from baseline
- Creatinine ≥1.5 times the upper limit of normal
- Cardiac arrhythmias or sudden death
- Priorities of assessment/treatment
- Is pt hemodynamically stable? Does pt have EKG abnormalities?
- Control electrolytes.
- What is pt’s renal function? Is hemodialysis needed?
- Pursue aggressive hydration if pt has adequate renal function.
- Does pt fit the profile of a pt at risk for tumor lysis?