The Internet Book of Critical Care Podcast IBCC Episode 51 - Tumor Lysis Syndrome
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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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Key Physiology of Tumor Lysis Syndrome
- Tumor lysis syndrome releases potassium, phosphate, calcium, and purine nucleotides that metabolize to uric acid and xanthine.
- Uric acid and xanthine can precipitate in kidneys, causing renal failure and complications.
Prefer Rasburicase Over Allopurinol
- Use rasburicase to degrade uric acid rather than allopurinol which blocks xanthine conversion and may cause xanthine accumulation.
- Commit to rasburicase therapy for best patient outcomes in tumor lysis syndrome.
Vicious Cycle of Kidney Injury
- Tumor lysis syndrome causes a vicious cycle where uric acid, xanthine, and calcium phosphate precipitate in the kidneys causing renal failure.
- Renal failure then leads to further accumulation and worsening of this cycle rapidly worsening patient condition.