Acute Tumor Lysis Syndrome (ATLS)

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?

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Last updated: April 14, 2010