Morning Report 12/28/15

  • Tumor lysis is most commonly seen in Burkitt’s lymphoma and other hematologic malignancies after initiation of cytotoxic chemotherapy
  • Spontaneous tumor lysis is rare
  • Risk factors for TLS include chemosensitive malignancies, bulky Dz > 10 cm, pretreatment hyperuricemia, and dehydration
  • Evaluation of the calcium, phosphorous, uric acid level, and potassium levels are the first step in diagnosis
  • Treatment consists of intravenous fluids, uric acid lowering agents, and possibly dialysis
  • Allopurinol decreases production of uric acid while rasburicase shunts uric acid into allantoin to minimize uric acid precipitation in the renal tubules
  • Can’t use Rasburicase in patients with G6PD deficiency
  • Stages of hyperkalemia
    • > 5.5 peaked Ts
    • >6.5 atrial paralysis –> p wave widens/flattens, prolonged PR, then P’s disappear
    • > 7.0 conduction abnormalities, bradycardia, wide QRS with bizzare morphology, sine wave
    • > 9.0 cardiac arrest, asystole, V fib

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