[Tumor lysis syndrome in intensive therapy: diagnostic and therapeutic encare].
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive release of nucleic acids, potassium and phosphate into the blood. This complication is the result of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterized by rapid capacity of proliferation, that is often hematological origin. Moreover, the TLS can be observed before starting the treatment due to spontaneous tumor cell death, and frequently worsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure. In the intensive care unit (ICU), physicians should be aware of the clinical characteristics of TLS, which results in severe electrolyte metabolism disorders, especially hyperkalemia, hyperphosphatemia and hypocalcemia, and acute kidney injury which is a major cause of ICU mortality. An adequate strategy for the management of the TLS, combining hydration, urate oxidase, and an early admission to ICU can control this complication in most patients. The aim of this review is to provide diagnostic tools that allow to the ICU physician to recognize the population at high risk for developing the TLS, and outline a proper strategy for treating and preventing this serious complication.
Cátedra y Centro de Tratamiento Intensivo del Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. burghig@gmail.com
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D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D000493:Allopurinol / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D015913:Chelation Therapy; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D005440:Fluid Therapy; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy / Q000209:etiology; D054559:Hyperphosphatemia / Q000188:drug therapy / Q000209:etiology; D006996:Hypocalcemia / Q000188:drug therapy / Q000209:etiology; D015994:Incidence; D015337:Multicenter Studies as Topic; D011379:Prognosis; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D014503:Urate Oxidase / Q000627:therapeutic use
D000970:Antineoplastic Agents; C469709:rasburicase; D000493:Allopurinol; D014503:Urate Oxidase