Etiology
How does TLS occur?
Rapid breakdown of tumor cells causes metabolic and electrolyte disturbances
What are the important lab results to monitor?
potassium, calcium, phosphorus, uric acid, and creatinine
If you see a uric acid level of 14, what do you do next?
contact provider and activate the Rasburicase protocol
What treatment for TLS?
Aggressive IV hydration and monitoring labs
Signs and Symptoms of Hyperuricemia & Hyperphosphatemia
Hyperuricemia: nausea & vomiting, diarrhea, little or no urine output, lathargy, edema, weight gain, crystals in urine, renal failure
Hyperphosphatemia: edema, weight gain, little to no urine output, renal failure
TLS occurs frequently in patients with this kind of cancer
Non-Hodgkin Lymphoma
Normal range of potassium
3.5-5.0 mEq/L
Patient at risk for TLS should have this order to monitor cardiac rhythm.
telemetry
This medication helps bind potassium in the digestive tract, preventing its absorption into the bloodstream and promoting its elimination in feces.
Lokelma (sodium zirkonium cyclosilicate)
Signs and Symptoms of Hypocalcemia
Restlessness, muscle cramps/twitching/spasm, altered LOC, seizure
What other hematologic malignancies could cause TLS?
Burkitt lymphoma, Acute lymphoblastic leukemia, and Acute myeloid leukemia
How often is it recommended to monitor lab results in high-risk patients?
Every 4 hours
True or False: Decrease urine output can be sign of TLS
True
These medications are used in treatment of hyperuricemia
Allopurinol and Rasburicase
Signs and Symptoms of Hyperkalemia
nausea & vomiting and cardiac dysrhythmia
TLS can occur in this patient that have this co-morbidity
Pre-existing renal dysfuction
Normal range of Phosphorus
2.5-4.5 mg/dL
Why should we assess and monitor vital signs and lung sounds?
Patients are at risk for fluid and cardiac abnormalities
This medication is no longer used in patients with TLS due to worsening of hypocalcemia
Urine Alkalization
Patients at risk for TLS should avoid foods that are high in these electrolytes
Potassium and phosphorus
Name one of the cancer treatments that can put a patient at risk for TLS, not including chemotherapies
B-cell lymphoma-2 (BCL-2) inhibitors(venetoclax), PI3K inhibitors(Idelalisib, Duvelisib), total body irradiation, monoclonal antibodies (rituximab, nivolumab), tyrosine kinase inhibitors (imatinib), Proteasome inhibitors (bortezomib), chimeric antigen receptor T-cells (CAR-T cells), proapoptotic agent (lenalidomide), corticosteroids
What kind of drug should be avoided for AKI in TLS?
nephrotoxicity agents
What is the normal urine output in an adult?
30 ml/hr
What treatment is used when potassium and phosphorus are excessively high due to tumor lysis syndrome?
Hemodyalysis
What diet should be avoided for the elevation of uric acid levels?
low purine diet such as seafood, fatty meat, organs, high-fat dairy products, and alcohol)