The Internet Book of Critical Care Podcast
IBCC Episode 51 - Tumor Lysis Syndrome
Aug 22, 2019
In this episode, the speakers discuss all things you need to know about tumor lysis syndrome including life-threatening hyperkalemia, purine nucleotide management, rasburicase, and dialysis. They highlight the importance of treating the underlying problem and monitoring calcium and phosphate levels. Risk factors, symptoms, and diagnosis of tumor lysis syndrome are explored, along with the difference between pseudohypocalcemia and hypercalcemia. The use of Respira case for tumor lysis syndrome management is discussed, including contraindications, potential risks, and dosing. The potential harm of using allopurinol in patients with tumor lysis syndrome is also highlighted, emphasizing the importance of dialysis and the indications for initiating it.
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Quick takeaways
- Preventing tumor lysis syndrome involves adjusting purine nucleotide metabolism and ongoing monitoring.
- In tumor lysis syndrome, renal function decline worsens the accumulation of uric acid, xanthine, and calcium phosphate.
Deep dives
Understanding the Physiology of Tumor Lysis Syndrome
Tumor lysis syndrome occurs when tumor cells break down, releasing calcium, phosphate, potassium, and purine nucleotides. Adenine and guanine metabolize into xanthine, which then converts into uric acid. Allopurinol can inhibit the conversion of xanthine to uric acid, but it may lead to xanthine accumulation. In patients who have access to rasburicase, allowing the pathway to progress towards uric acid is preferred.
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