Oncologic emergency. Kourosh Goudarzipour Jan-2014. list. TLS Chemotherpy guideline in TLS Mediastinal mass and SVC syndrome VOD Seizure Leukostasis Cardiac tamponade thyphlitis. TLS. REFRENCES.
Dexamethasone (4 mg) was administered intramuscularly, and loratadine was prescribed.
potassium, 5.9 mmol per liter; bicarbonate, 16 mmol per liter; creatinine, 1.0 mg per deciliter phosphorus, 8.5 mg per decilitereruric acid, 12.3 mg per deciliter.
two or more of the following metabolic abnormalities occur within 3 days before or up to 7 days after the initiation of therapy.
The corrected calcium level in milligrams per deciliter = measured calcium level in milligrams per deciliter + 0.8 × (4 − albumin in grams per deciliter).
in contrast to Cairo and Bishop’s definition, a 25% change from baseline should not be considered a criterion, since such increases are rarely clinically important unless the value is already outside the normal range.
New england journal-2012
If urine output < 60 % of intake within the first 4 hours of IV hydration and there are no signs of volume overload (e.g. hypertension, tachypnea hypoxemia, S3 gallop), give normal saline boluses (10 cc/kg x 2).
Give first dose of Rasburicase as soon as HR-TLS criteria for elevated uric acid are met, even if therapy is not to start immediately.
When patient is on treatment with Rasburicase, blood samples for uric acid measurements should be kept in ice until analyzed, to prevent continuing ex-vivo degradation of uric acid by rasburicase and thus, falsely low uric acid levels.
Start chemotherapy when good urine ouput is established and uric acid is < normal limits, regardless of urine pH.
If serum K > 6.0 - 6.5 mEq/l and EKG is normal , Consult Renal service for potential need for dialysis. Initiate one or more of the following measures:
Insulin: Regular insulin 0.1 U/kg in 2 cc/kg ( = 0.5 gr/kg)of 25 % Dextrose IV over 30 minutes.
Albuterolnebulization, Insulin with hypertonic glucose, Sodium bicarbonate
Warning: Extravasation of calcium can result in severe tissue necrosis. Except in extreme emergencies, IV calcium should always be administered via a central line.
Drugs that are primarily excreted by other routes can be given in standard doses (i.e. vincristine, vinblastine, dactinomycin) or at slightly reduced dosages ( i.e. cyclophosphamide) in patients with renal failure.
dialysis not be initiated earlier than 12 hours after CYC infusion to avoid excessive drug removal ( and thus, lessening treatment efficacy).