HYPERURICEMIA (TLS)

8TH NOVEMBER 2018 NCM 106—ONCOLOGY NURSING

Source: Oncology Nursing, 5th Ed. Langorne, Martha E., Fulton, Janet S., & Otto, Shirley E.
Definition
Tumor lysis syndrome (TLS) is characterized
by an array of metabolic imbalances associated
with the rapid destruction of a large number of
WBCs. that develop in patients with cancer af-
ter the onset of chemotherapy treatment or,
less often, prior to treatment.
TLS has been reported most often in patients’
suffering from malignancies with a high rate of
proliferation, especially cancers with a high re-
sponse rate and rapid responses to cytotoxic
therapy.
These include aggressive non-Hodgkin lympho-
ma, notably diffuse large B-cell lymphoma, lym-
phoblastic lymphoma, and Burkitt lymphoma; Clinical Features
acute and chronic leukemias; and, less often, Hyperuricemia
bulky solid tumors.
GI: Nausea, Vomiting, Diarrhea, Anorexia
Occurs 24-48 hours into treatment
Renal: Edema, Flank Pain, Hematuria, Oliguria, Cloudy, sediment
May persist up to one week
in urine, Anuria, Azotemia, Crystalluria
Etiology & Risk Factors
Neuromuscular: Lethargy, Goutlike Symptoms
Following the administration of therapy, malig-
nant cells are destroyed rapidly releasing into Treatment Modalities
circulation intracellular components. Prevent TLS by recognizing the patient population who is at risk
 high tumor burden and initiating prophylactic measures before initiation of antineo-
plastic therapy.
 high rate of proliferation
Hydration should begin 24 to 48 hours before treatment and con-
 and disease that is highly responsive to
therapy tinue for at least 72 hours after treatment. This is to maintain a
urinary output of 100 ml/hr.
 Bulky tumors ( > 8-10cm)
Diuretics – to promote the excretion of phosphate and uric acid.
 Pre-existing hyperuricemia
Allopurinol – prevents uric acid formation.
 ≥ 60 years old
Rasburicase – used in treatment and prevention of chemotherapy
-induced hyperuricemia.
Rasburicase lowers preexisting uric acid.
Sodium Bicarbonate – used to maintain an alkaline urine (pH>7)
to prevent uric acid crystallization (50 to 100 mEq/L fluid or 50
mEq by IV bolus).
Acetazolamide – used to decrease bicarbonate resorption in the
kidney so that it is excreted in the urine where it enhances alka-
linization.
Nursing Considerations
 Careful monitoring of lab values. (uric acid
levels)
 Assess medications for those that contain
phosphate and discuss discontinuation with
physician.
 Assess patient for signs and symptoms of
TLS (Hyperuricemia).
 Administer diuretics, sodium bicarbonate, as
appropriate.
 Monitor I/O and notify physician if urinary
output is less than 7.0 with sodium bicar-
bonate.
 Prepare the patient and family for dialysis if
other measures are not effective.
 Be prepared to transfer patient to the ICU for
hemodynamic monitoring.
 Assess the patient for jugular venous disten-
tion and peripheral edema.