- 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
SCVMC IM Chief Resident Blog 