1. 主講者 : 黃馨瑩 指導者 : 李偉政 96-09-27

12. Pathophysiology 96-09-27

19. Mechanisms of action 96-09-27

21. Rampello E et al. (2006) The management of tumor lysis syndrome Nat Clin Pract Oncol 3 : 438 – 447 doi:10.1038/ncponc0581 Table 2 Solubility of purine analogs and calcium phosphate at pH 5.0 and 7.0 96-09-27

23. Diagnostic evaluation 96-09-27 History of malignancy Symptom and sign of metabolic abnormality and complications prior to or after chemotherapy Management: Hydration and diuretics Correct electrolyte imbalance Hemodialysis if needed Urine alkalization: controversial. TLS?? 4 “H” Presence of risk factor Work up: Laboratory: electrolyte, LDH, RFT, urine pH, EKG Image studies Others: Monitor I/O, fluid status, histologic findings

26. Rampello E et al. (2006) The management of tumor lysis syndrome Nat Clin Pract Oncol 3 : 438 – 447 doi:10.1038/ncponc0581 Table 3 Tumor lysis syndrome management 96-09-27

31. Mechanism of Action Recommended dosing: 0.15 or 0.20 mg/kg/d for 5 d 96-09-27

32. Management 25~50gm Q6h Kayexalate Exchange resins Insulin + dextrose 1meq/kg IV 50~100meq/L IVF Sodium bicarbonate Intracellular potassium transporters Hyperkalemia 10ml Q2h for 12x/day Aluminum hydroxide Phosphate-binding agents Hyperphosphatemia 10% calcium chloride: K + ↑: 2~4mg/kg Q6~8h prn K + ↓: 0.5~1gm Q1~3d Calcium gluconate; Calcium chloride Mineral Hypocalcemia 0.15~0.2mg/kg/d for 5~7 d Rasburicase Uric acid oxidizers Prophylaxis: 200~600mg/dl Tx: 600~900mg/dl Allopurinol Xanthine oxidase inhibitors Hyperuricemia Dose Drug name Drug category Metabolic abnormality