Tumor lysis syndrome - Revision history

Danbot: Add MedicationDose SMW entries for rasburicase, allopurinol, calcium gluconate; doses verified against oncology/hematology guidelines

2026-03-20T17:57:40Z

Add MedicationDose SMW entries for rasburicase, allopurinol, calcium gluconate; doses verified against oncology/hematology guidelines

← Older revision		Revision as of 17:57, 20 March 2026
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	[[Category:Heme/Onc]]		[[Category:Heme/Onc]]
			==Medication Dosing==
			===Hyperuricemia===
			*{{MedicationDose\|drug=Rasburicase\|dose=0.05-0.2 mg/kg\|route=IV\|context=Urate oxidase (prevention and treatment)\|indication=Tumor lysis syndrome\|population=Adult\|notes=Converts uric acid to allantoin; contraindicated in G6PD deficiency}}
			*{{MedicationDose\|drug=Allopurinol\|dose=200-400 mg/m2 q12hr (or 10 mg/kg/day PO divided q8hr)\|route=IV/PO\|context=Xanthine oxidase inhibitor (prevention only)\|indication=Tumor lysis syndrome\|population=Adult\|notes=Renally dosed; only prevents future uric acid production}}

			===Symptomatic Hypocalcemia===
			*{{MedicationDose\|drug=Calcium gluconate\|dose=50-200 mg\|route=IV\|context=Symptomatic hypocalcemia\|indication=Tumor lysis syndrome\|population=Adult\|notes=Treat only if symptomatic; avoid overcorrection (increases Ca-phos deposition)}}

NadavNahumi: /* Background */

2020-03-19T02:18:19Z

Background

← Older revision		Revision as of 02:18, 19 March 2020
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	==Background==		==Background==
			*Typically occurs within 1 to 5 days of initiation of chemotherapy
	*Associated with treatment of acute [[leukemia]], Burkitt [[lymphoma]], NHL		*Associated with treatment of acute [[leukemia]], Burkitt [[lymphoma]], NHL
	**Rarely observed in solid tumors or without prior therapy		**Rarely observed in solid tumors or without prior therapy

ClaireLewis: /* Management */

2019-10-01T18:58:18Z

Management

← Older revision		Revision as of 18:58, 1 October 2019
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	*See [[Hyperkalemia]] for treatment options		*See [[Hyperkalemia]] for treatment options

	===Dialysis (Criteria)===		===[[Dialysis]] Criteria===
	*Potassium >6		*Potassium >6
	*Significant renal insufficiency (Creatinine >10)		*Significant renal insufficiency (Creatinine >10)

ClaireLewis at 04:05, 25 August 2019

2019-08-25T04:05:35Z

← Older revision		Revision as of 04:05, 25 August 2019
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	==Background==		==Background==
	*Associated with treatment of ~~ALL~~, Burkitt lymphoma, NHL		*Associated with treatment of acute [[leukemia]], Burkitt [[lymphoma]], NHL
	**Rarely observed in solid tumors or without prior therapy		**Rarely observed in solid tumors or without prior therapy
	*Rapid turnover of tumor cells (spontaneously or after treatment) leading to release of:		*Rapid turnover of tumor cells (spontaneously or after treatment) leading to release of:
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	==Clinical Features==		==Clinical Features==
	*Hyperuricemia		*Hyperuricemia
	**Nausea/vomiting, lethargy, renal failure		**[[Nausea/vomiting]], [[lethargy]], [[renal failure]]
	*[[Hyperkalemia]]		*[[Hyperkalemia]]
	**Most immediate life-threatening element (due to ~~dysrrhythmias~~)		**Most immediate life-threatening element (due to [[dysrhythmias]])
	*Hyperphosphatemia		*[[Hyperphosphatemia]]
	**May combine with Ca to precipiate in renal tubules		**May combine with Ca to precipiate in renal tubules
	*[[Hypocalcemia]]		*[[Hypocalcemia]]
	**Anorexia, cramping, tetany, confusion, seizures, [[V-tach]]/[[torsades]]		**Anorexia, cramping, tetany, [[confusion]], [[seizures]], [[V-tach]]/[[torsades]]
	*[[Acute Renal Failure]]		*[[Acute Renal Failure]]
	**Most common cause of morbidity		**Most common cause of morbidity
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	==Management==		==Management==
	~~Agressive~~ hydration - Goal urine output is 3L in 24hr		Aggressive hydration - Goal urine output is 3L in 24hr

	===[[Hypocalcemia]] Treatment===		===[[Hypocalcemia]] Treatment===
	*≤7 or 25% decrease in baseline		*≤7 or 25% decrease in baseline
	**Treat only if symptomatic (increased Ca leads to increased Ca/phos deposition), such as widened QRS or ventricular arrhythmias		**Treat only if symptomatic (increased Ca leads to increased Ca/phos deposition), such as widened QRS or ventricular arrhythmias
	**Calcium gluconate 50-200mg IV		**[[Calcium gluconate]] 50-200mg IV

	{{Hyperphosphatemia treatment}}		{{Hyperphosphatemia treatment}}

Ostermayer: /* Hyperkalemia */

2019-05-13T15:34:38Z

Hyperkalemia

← Older revision		Revision as of 15:34, 13 May 2019
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	****Urate oxidase converts uric acid to allantoin (5-10x more soluble)		****Urate oxidase converts uric acid to allantoin (5-10x more soluble)

	===[[Hyperkalemia]]===		===[[Hyperkalemia]] Treatment===
	*Only give Ca for cardiovascular instability (e.g.ventricular arrhythmias, widened QRS)		*Only give Ca for cardiovascular instability (e.g.ventricular arrhythmias, widened QRS)
	**Giving Ca leads to increased Ca/phos deposition which leads to renal failure		**Giving Ca leads to increased Ca/phos deposition which leads to renal failure

Ostermayer: /* Hyperuricemia */

2019-05-13T15:34:22Z

Hyperuricemia

← Older revision		Revision as of 15:34, 13 May 2019
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	*Consider sevelamer 800-1600mg PO tid to avoid side effects of aluminum toxicity and hypercalcemia from aluminum hydroxide treatment		*Consider sevelamer 800-1600mg PO tid to avoid side effects of aluminum toxicity and hypercalcemia from aluminum hydroxide treatment

	===Hyperuricemia===		===Hyperuricemia Treatment===
	*≥8 or 25% increase		*≥8 or 25% increase
	**[[Allopurinol]]		**[[Allopurinol]]

Ostermayer: /* Hyperphosphatemia */

2019-05-13T15:33:59Z

Hyperphosphatemia

← Older revision		Revision as of 15:33, 13 May 2019
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	**Calcium gluconate 50-200mg IV		**Calcium gluconate 50-200mg IV

	~~===[[Hyperphosphatemia]]===~~
	{{Hyperphosphatemia treatment}}		{{Hyperphosphatemia treatment}}
	*Consider sevelamer 800-1600mg PO tid to avoid side effects of aluminum toxicity and hypercalcemia from aluminum hydroxide treatment		*Consider sevelamer 800-1600mg PO tid to avoid side effects of aluminum toxicity and hypercalcemia from aluminum hydroxide treatment

Ostermayer: /* Hypocalcemia */

2019-05-13T15:33:47Z

Hypocalcemia

← Older revision		Revision as of 15:33, 13 May 2019
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	Agressive hydration - Goal urine output is 3L in 24hr		Agressive hydration - Goal urine output is 3L in 24hr

	===[[Hypocalcemia]]===		===[[Hypocalcemia]] Treatment===
	*≤7 or 25% decrease in baseline		*≤7 or 25% decrease in baseline
	**Treat only if symptomatic (increased Ca leads to increased Ca/phos deposition), such as widened QRS or ventricular arrhythmias		**Treat only if symptomatic (increased Ca leads to increased Ca/phos deposition), such as widened QRS or ventricular arrhythmias

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T22:45:04Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 22:45, 30 May 2017
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	**[[Allopurinol]]		**[[Allopurinol]]
	***Acts slowly; only helpful for preventing future production of uric acid		***Acts slowly; only helpful for preventing future production of uric acid
	***10mg/kg/d PO q8 OR 200-400mg/m2 IV q12; renally dosed		***10mg/kg/d PO q8 '''OR''' 200-400mg/m2 IV q12; renally dosed
	***Inhibition of xanthine oxidase can last 18-30h		***Inhibition of xanthine oxidase can last 18-30h
	**Urate Oxidase		**Urate Oxidase

Alvarez13 at 01:14, 6 December 2016

2016-12-06T01:14:37Z

← Older revision		Revision as of 01:14, 6 December 2016
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	***Inhibition of xanthine oxidase can last 18-30h		***Inhibition of xanthine oxidase can last 18-30h
	**Urate Oxidase		**Urate Oxidase
	***Rasburicase 0.05-0.2mg/kg IV		***[[Rasburicase]] 0.05-0.2mg/kg IV
	***Can be used for BOTH prevention and treatment		***Can be used for BOTH prevention and treatment
	***Uric acid final product of purine metabolism		***Uric acid final product of purine metabolism