Hypercalcemia
Mrs Jones presents to the AIC with history of breast cancer. You obtain labs prior to chemo and discover that her calcium is 11.0. You also note that her weight has dropped 10 pounds since her last visit. This is the next step to fully evaluate for hypocalcemia.
What is to check albumin level?
Which patient is at the highest risk for developing tumor lysis syndrome
a. 36yo male with stage 1a lung cancer
b. 48 yo female with 4cm left sided breast cancer c. 60 yo male with newly diagnosed B cell lymphoma
d. 80 yo female with recurrent pancreatic cancer
What is B cell lymphoma
Most commonly seen in pts with aggressive and highly aggressive lymphomas and ALL
Al of the following findings neurological deficits would alert you to a possible spinal cord compression except: a. Increased rectal tone b. Distended bladder c. Erectile dysfunction d. Hyperreflexia
What is increased rectal tone
This medication has been shown to be superior to allopurinol alone in time to control serum uric acid in patients at risk for TLS.
What is rasburicase?
This is the name for the definition of laboratory tumor lysis syndrome.
a. Cairo-Bishop
b. Tumor lysis syndrome laboratory levels (TLSLL)
c. PUPC Index (Potassium, uric acid, phosphorous, calcium)
d. Egypt-Knight
What is Cairo-Bishop?
Uric acid > 8 mg/dl or 25% increase from baseline
K > 6 mEq/L or 25% increase from baseline
Phos >4.5 mg/dL or 25% increase from baseline
Calcium <7 mg/dL or 25% decrease from baseline
First line treatment for hypercalcemia is
a. Pamidronate b. Dexamethasone c. Hydration d. Low calcium diet
What is hydration?
This lab would be one you would review to assess a patient's risk of developing TLS.
a. Potassium b. Ammonia c. Sodium d. Magnesium
What is potassium?
Significant elevations in uric acid, potassium, phosphorus, and significant decrease in calcium are seen in tumor lysis syndrome.
Which of the following would be considered first line treatment for spinal cord compression? A. Tylenol B. Vicodin C. Decadron D. Muscle relaxers
What is decadron?
As opposed to allopurinol which decreases uric acid formation, this medication lowers serum uric acid acutely by breaking down serum uric acid.
What is rasburicase?
Rapidly breaks down serum uric acid
This may be a symptom of hypocalcemia
A. Abdominal pain B. Constipation C. Tetany D. Shortness of breath
What is tetany?
All of the following are sign of hypercalcemia except: a. Weakness, lethargy b. Confusion c. Nausea, anorexia d. Jaundice, lymphedema
What is jaundice, lymphedema
All of the following you would expect to see in TLS except:
a. Hyperkalemia b. Hyperuricemia c. hypocalcemia d. Hyperglycemia
What is hyperglycemia?
All of the following may be side effects of steroids except: A. GI upset B. Insomnia C. Irritability D. Forgetfulness
What is forgetfulness?
This medication used to treat TLS can cause severe methemoglobinemia.
What is rasburicase?
Tx includes discontinuing rasburicase and considering use of methylene blue and vitamin C.
These tumors are most frequently associated with TLS
What are clinically aggressive NHLs and acute lymphoblastic leukemia, particularly Burkitt lymphoma/leukemia.
The patient was admitted to the hospital and given hydration as well as pamidronate (aredia). What symptom would be worrisome to you if she called the office 2 days after treatment?
a. Headache b. Cough c. Muscle cramps d. Dysuria
What are muscle cramps?
These signs and symptoms alert you to the presence of TLS:
a. Muscle cramps, constipation, paresthesias
b. Lethargy, hematuria, diarrhea, nausea
c. Hypotension, abdominal pain, blurred vision
d. Weight gain, weakness, constipation
What is lethargy, hematuria, diarrhea, nausea?
This is the median survival time for someone with neoplastic epidural spinal cord compression:
a. 2 years
b. 6 mo
c. 6 years
d. 2 weeks
e. not been studied
Better prognosis for those who are ambulatory
This medication should NOT be given to patients with G6PD deficiency.
What is rasburicase?
Hydrogen peroxide is byproduct of uric acid breakdown and can cause severe hemolysis in pts with G6PD deficiency.
High levels of this lead to secondary hypocalcemia in tumor lysis syndrome?
What is phosphatemia.
Malignant cells contain up to 4 x the phosphorus as found in normal cells.
You are getting ready to discharge your hypercalcemic patient. when reviewing her discharge medications, this medication gives you cause for concern.
a. Lasix b. Tums c. Pepcid d. norvasc
What is tums?
All of the following are appropriate measures to decrease the risk of TLS except:
1. Allopurinol
2. Bicarb
3. Dietary restriction of calcium and phosphorous 4. rasburicase
What is dietary restriction of calcium and phosphorous
a. Cord compression classification (CCC)
b. Pain and instability score (PIS)
C. Spine instability neoplastic score (SINS)
D. Vertebral Compression Severity Index
What is spine instability score?
Takes in to account pain, location, lytic/blastic, radiographic findings, vertebral body collapse, and invasion of the tumor. A score greater than 7 warrants surgical consultation.
This medication can be used for TLS prevention as well as allopurinol.
What is rasburicase?
This is the appropriate way for blood samples of uric acid to be collected for patient receiving rasburicase.
Pre-chilled tube, then immediately placed on ice, and the assay completed within four hours
if possible