Treating TLS Complications

 

A patient who develops TLS requires ongoing hydration. Asymptomatic hyperkalemia is managed with sodium polystyrene sulfonate with sorbitol given orally. Monitor the patient for signs and symptoms of hypocalcemia and hypomagnesemia from sodium polystyrene sulfonate with sorbitol.10 Also monitor the patient's 12-lead ECG as indicated and assess cardiac rate and rhythm for dysrhythmias. If the patient has symptomatic hyperkalemia, the health care provider may order IV regular insulin and dextrose to redistribute potassium, shifting it intracellularly. IV calcium chloride may be ordered to control dysrhythmias by antagonizing the toxic effects of hyperkalemia at the cardiac cellular membrane level and managing hypocalcemia. IV calcium should not be administered, however, to patients with hyperphosphatemia, because it promotes calcium phosphate precipitates. Hyperphosphatemia is managed with phosphate binders such as aluminum hydroxide given in limited dosages to avoid aluminum toxicity. Other phosphate binders with calcium, such as calcium acetate or calcium carbonate, may be used instead. A patient who does not respond to these measures may need renal replacement therapy, such as hemodialysis, to manage electrolyte abnormalities and treat renal failure.