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What is All are true regarding Tumor lysis syndrome except: and explain in detail?
Ref: Harrisons Principles of Internal Medicine, 18,th edition, pg 2274Explanation:Tumor lysis syndrome (TLS)Characteristic biochemical changes in Tumor lysis SyndromeHyperuricemia,Hyperkalemia,Hypocalcemia,Hyperphosphatemia.AcidosisAcute renal failure.Caused by destruction of large number of rapidly multiplying neoplastic cells: During Burkin's lymohoma. ALL. CLL on chemotherapyChemotherapy commonly associated are-Fludarabine.Letrozole,Tamoxifen.Glucocorticoids,RituximabGemtuzumabAcute hyperurecemic nephropathy- urinary uric acid ! urine creatinine > 1High calcium:phosphate ratio - renal failureTumor burden, hyperuricemia & high LDH - high risk for TLS.TreatmentAllopurinolRasburicase (recombinant urate oxidase): contraind in G6PD deficiency, can cause bronchospasm, hypotension & hypoxiaAggressive hydration with Vi NSUrinary alkalinization with pH > 7 with IV sodium bicarbonateHemodialysis/hemofUtration:If S.potassium > 6;S. Uric acid > 10.S.Phosphate >10.S.Creat > 10 with severe hypocalcemiaCauses of hypercalcemia: VITAMINS TRAPVitamin D, A intoxication. VIPomaImmobilisationThiazide. TPNAddison'sMilk-alkali syndromeInfection: TuberculosisNeoplasm- Myeloma, secondary depositsSarcoidosisTuberculosis, ThyrotoxicosisRadiationAIDSParathyroid excess- primary /tertiary; Paget's