Treatment of Electrolyte Abnormalities in a Patient with the Tumor Lysis Syndrome

 

Common serum electrolyte abnormalities:

(1) hyperphosphatemia

(2) hypocalcemia (serum calcium <= 1.75 mmol/L, <= 6.0 mg/dL)

(3) hyperkalemia

 

The presence of renal dysfunction may impair the ability of the body to excrete the electrolyte loads.

Electrolyte Problem	Severity	Management
hyperphosphatemia	moderate (serum phosphate >= 2.1 mmol/L)	avoid IV infusion of phosphate; administer phosphate binders
	severe	as for moderate; dialysis or hemofiltration
hypocalcemia	asymptomatic	no treatment but monitor levels
	symptomatic	calcium gluconate 50-100 mg per kg IV given slowly with ECG monitoring
hyperkalemia	moderate (>= 6.0 mmol/L) and asymptomatic	avoid oral or IV potassium; monitor ECG, consider sodium polystyrene sulphonate
	symptomatic	as for moderate plus see note below
	severe (> 7 mmol/L	as for moderate plus see note below

 

where:

• Sodium polystyrene sulphonate is a cation exchange resin that is insoluble in water.

 

Treatment for symptomatic or severe hyperkalemia:

(1) consider dialysis

(2) calcium gluconate 100-200 mg/kg by slow IV infusion if the patient has life-threatening arrhythmias (monitor ECG during the infusion and do not infuse through the same line as the sodium bicarbonate)

(3) inject regular insulin 0.1 U/kg IV while infusing D25W 2 mL/kg

(4) sodium bicarbonate 1-2 mEq/kg IV push (do not infuse through the same line as the calcium gluconate)

 

Treatment of renal dysfunction:

(1) control and monitor fluid and electrolyte intake and excretion

(2) monitor and manage uric acid and phosphate levels

(3) adjust drug dosages for the creatinine clearance

(4) consider dialysis or hemofiltration