Canterbury DHB

Context

Management of Tumour Lysis Syndrome

The features of tumour lysis can be present at presentation or may develop within hours of starting treatment:

In This Section

Aggressive Hydration

Rasburicase (recombinant form of urate oxidase)

Rasburicase Dosage

Hyperkalaemia

Hyperphosphataemia

Hypocalcaemia

Renal Failure

Aggressive Hydration

Obtain a forced diuresis using oral and IV fluids 2-3 L/m2/day ± diuretics. Aim for 80 mL/m2/hour of urine.

Strict Fluid balance, BD weights, and diuretics are required to ensure the patient is maintaining a good diuresis.

Rasburicase (recombinant form of urate oxidase)

Rasburicase Dosage

Hyperkalaemia

Hyperphosphataemia

Restrict phosphate in the diet. The high phosphate should resolve within a day of the TLS. Nonabsorbable intestinal “phosphate binders” are unlikely to be of use in the acute setting.

Hypocalcaemia

Treatment of symptomatic hypocalcaemia (tetany, seizures, cardiac arrhythmias (heart block or ventricular arrhythmias)) with IV calcium is appropriate. See Hypocalcaemia on Hospital HealthPathways. Start with calcium gluconate IV 10 mL of 10% solution as bolus over 2 minutes.

Renal Failure

In the presence of renal failure prior to treatment, renal ultrasound or CT scanning is indicated to exclude obstructive uropathy. This should be relieved by ureteric stents or temporary insertion of nephrostomy tubes.

Early renal failure with weight increase and urine output decrease may respond to IV frusemide 2 mg/kg IV. Up to 5 mg/kg may be given as single dose. Plasma filtration may be a useful alternative to dialysis if fluid overload alone is the problem. This should be done through radial/brachial arterial line and central venous return.

Peritoneal dialysis (PD) is usually the first choice in the event of:

About this Canterbury DHB document (5737):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

January 2019

Next Review:

January 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5737