Tumor Lysis Syndrome (TLS)

Potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or
chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma,
and small cell lung cancer.
The release of tumor intracellular contents (nuclei acids, electrolytes, and debris) leads to rapidly induced
electrolyte imbalances—hyperkalemia(cardiac) hyperphosphatemia (leading to hypocalemia)(neuro),
and hyperuricemia (________)—that can have life-threatening end-organ effects on the myocardium,
kidneys, and central nervous system
 Monitor for gout: increased uric acid levels, joint pain, edema
 Dietary modifications: small, frequent meals
 Increase fluid intake: 2500 to 3000 mL/day
 Report excessive weight loss, change in level of consciousness, paresthesia
 Protective Isolation
 Support!!
Med Management
To prevent kidney injury and restore electrolyte balance, aggressive fluid hydration is initiated 24–48 hours
before and after the initiation of cytotoxic therapy to increase urine volume and eliminate uric acid and
electrolytes;
Diuresis with a loop diuretic or osmotic diuretic if urine output is not sufficient
Allopurinol (prevent)therapy to inhibit the conversion of nucleic acids to uric acid; rasburicase may be used to
convert already formed uric acid to allantoin, which is highly water soluble and eliminated in urine.
Administration of a cation-exchange resin, such as sodium polystyrene sulfonate (Kayexalate), to treat
hyperkalemia by binding and eliminating potassium through the bowel
 Doxorubicin is a type of chemotherapy drug called an anthracycline.
 It slows or stops the growth of cancer cells by blocking an enzyme called topo isomerase 2.
 Cancer cells need this enzyme to divide and grow.
 Mesna is a drug used to reduce the undesired side effects of certain chemotherapy drugs. It is referred to
as a "chemoprotectant.
 Know teaching points for all medications!!!
 Ifosfamide is an alkylating and immunosuppressive agent used in chemotherapy for the treatment of
cancers, including testicular cancer, ovarian cancer, cervical cancer, osteocarcinoma, bladder cancer,
small cell lung cancer, and non-Hodgkin's lymphoma.
 Administration of IV sodium bicarbonate, hypertonic dextrose, and regular insulin temporarily shifts
potassium into cells and lowers serum potassium levels if a rapid decrease in potassium is necessary.
 Administration of phosphate-binding gels, such as aluminum hydroxide, to treat hyperphosphatemia by
promoting phosphate excretion in the feces
 Hemodialysis when patients are unresponsive to the standard approaches for managing uric acid and
electrolyte abnormalities.
 Identify at-risk patients.
 Institute essential preventive measures (e.g., fluid hydration, medications) as prescribed.
 Assess patient for signs and symptoms of electrolyte imbalances.
 Assess urine pH to confirm alkalization.
 Monitor serum electrolyte and uric acid levels for evidence of fluid volume overload secondary to
aggressive hydration.
 Instruct patients to monitor for and report symptoms indicating electrolyte disturbances.
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