Prevention & Treatment

 

To help prevent TLS, assess patients undergoing chemotherapy for risk factors at baseline and monitor them during and after the start of treatment as ordered. The mainstays of preventive care are hydration and allopurinol and recombinant urate oxidase (rasburicase). Alkalinization of the urine, once a common treatment for TLS, is no longer routinely recommended. IV hydration should begin as soon as possible—ideally two days before initiating chemotherapy, and continue during chemotherapy and for two to three days afterward. The optimal fluid volume administered parenterally is 3,000 mL/m2 each day. This will produce the high urine output (over 100 mL/m2 each hour) needed to excrete excess potassium, phosphate, and uric acid, with the goal of reducing the risk of calcium phosphate precipitates.

Electrolytes, such as potassium, are not added to IV fluids to avoid the risk of worsening electrolyte abnormalities. Patients should be monitored for signs and symptoms of fluid volume overload, such as peripheral edema, neck vein distension, weight gain, and pulmonary crackles, as well as signs and symptoms of fluid volume deficit (dehydration), such as dry mucous membranes, poor skin turgor, weight loss, and thirst. Use physical assessment, strict intake and output, daily weights, and lab work results to monitor renal function, including serum creatinine and BUN levels, and calcium, phosphate, potassium, and uric acid levels. In some cases, the health care provider may order a diuretic such as furosemide to enhance renal excretion, but diuretics should be avoided in patients who are dehydrated or who have renal obstruction.