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
  • Laboratory
    • 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
  • Clinical
    • Creatinine ≥1.5 times the upper limit of normal
    • Cardiac arrhythmias or sudden death
    • Seizures
• 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?