Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T13:01:34Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

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	* Life-threatening syndrome of hyperuricemia and electrolyte abnormalities caused by sudden, massive cellular lysis that sometimes follows initiation of treatment for hematologic malignancies		* Life-threatening syndrome of hyperuricemia and electrolyte abnormalities caused by sudden, massive cellular lysis that sometimes follows initiation of treatment for hematologic malignancies

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Symptoms relate to underlying electrolyte abnormalities		* Symptoms relate to underlying electrolyte abnormalities

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2020-07-04T01:18:00Z

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== Definition ==

* Life-threatening syndrome of hyperuricemia and electrolyte abnormalities caused by sudden, massive cellular lysis that sometimes follows initiation of treatment for hematologic malignancies

== Clinical Presentation ==

* Symptoms relate to underlying electrolyte abnormalities
* Nausea, vomiting, diarrhea, anorexia, lethargy, hematuria, heart failure, cardiac dysrhythmias, seizures, muscle cramps, tetany, syncope, and possible sudden death

== Investigations ==

* Labs
** Hyperkalemia ≥6 or 25% above baseline
** Hyperphosphatemia ≥1.45 in adults (of ≥2.1 in children) or 25%
** Hypocalcemia ≤1.75 or 25% below baseline
** Hyperuricemia ≥476 or 25% above baseline
** High LDH
** Elevated creatinine

== Classification (Cairo-Bishop) ==

=== Laboratory TLS ===

* Any two or more abnormal serum values:
** Uric acid ≥476 umol/L or 25% above baseline
** Potassium ≥6 mmol/L or 25% above baseline
** Phosphorus ≥1.45 mmol/L or 25% above baseline
** Calcium ≤1.75 mmol/L or 25% below baseline
* Present within 3 days before or 7 days after instituting chemotherapy
* In the setting of adequate hydration (with or without alkalinization) and use of a hypouricemic agent

=== Clinical TLS (CTLS) ===

* Laboratory TLS plus one or more of the following:
** Increased serum creatinine concentration (≥1.5 times the upper limit of normal [ULN])
** Cardiac arrhythmia/sudden death
** Seizure

== Management ==

=== Acute ===

* Allopurinol
* Rasburicase preferred in renal failure
* Lots of IV fluids
* Monitor potassium closely

=== Prevention ===

* Allopurinol preferred to rasburicase at a dose of 100 mg/m^2^ q8h
** Dose-reduce for renal function

[[Category:Oncology]]

Tumour lysis syndrome - Revision history

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

Maintenance script: Imported from text file