Tumor Lysis Syndrome
Chemotherapy isn't good for you. So when you feel bad, as I am feeling now, you think, 'Well that is a good thing because it's supposed to be poison. If it's making the tumor feel this queasy, then I'm OK with it - Christopher Hitchens
image by: GDJ
The release of intracellular potassium, phosphorus, and nucleic acids into the extracellular space due to rapid destruction of tumor cells can result in detrimental metabolic derangement in tumor lysis syndrome.
Initial management involves recognition of the syndrome, high volume intravenous fluid administration as tolerated, decreasing uric acid production through allopurinol, decreasing uric acid levels through rasburicase if indicated, and determining the need for renal replacement therapy (RRT).
Usually occurs 12-72 hours after chemotherapy but can occur spontaneously (usually less hyperphosphatemia in this case, presumably due to recycling of phosphate).
The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers.
There are a few oncologic emergencies that every internist should be able to identify and manage. This is one of them.
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