(精选)【持续性肾脏替代治疗CRRT英文精品课件】Oncology Emergencies in PICU教学课件.pptVIP

* Norah Khathlan MD Pediatric Intensivist Director PICU November 2006 Oncology Emergencies in the PICU MEDIASTINAL MASSES SVC Syndrome HYPERLEUKOCYTOSIS TUMOR LYSIS SYNDROME SEPTIC SHOCK ARDS SPINAL Cord Compression. CNS Events Oncology Emergencies in the PICU 1- TUMOR LYSIS SYNDROME Metabolic abnormalities occurring as a result of tumor cell death: Spontaneously Chemotherapy Starting chemotherapy on rapidly growing-chemo-sensitive tumors ? release of intracellular contents into circulation. TUMOR LYSIS SYNDROME Hyperkalemia. Hyperphospatemia. 2ry Hypocalcemia. Hyperuricemia. Uremia. High creatinine. Oliguria. TUMOR LYSIS SYNDROME Incidence: 70% of hematological malignancies ? laboratory criteria of TLS. 3% with clinical TLS. Associated with hematological malignancies: ALL AML Lymphomas Solid tumors TUMOR LYSIS SYNDROME Maybe precipitated by : Chemotherapy steroids Radiotherapy. Hormonal agents. Risk factors: Tumor type Dehydration Preexisting renal insufficiency Nephrotoxic medications High LDH in TLS is indicative of likely progression to ARF TUMOR LYSIS SYNDROME MANAGEMENT: Identify at risk patients. Admit to PICU. Consult Nephrology service Establish good venous access prefer. CVC. Frequent lab monitoring of: - Na+ - Ca++ - K+ - Uric acid - Cl- - Creatinine - PO4++ - Urea - Bicarbonate - LDH TUMOR LYSIS SYNDROME MANAGEMENT: cont. Urine analysis and pH HYDRATION THERAPY: 2-3 L/m2/day OR 1 1/2 to 2 x maintenance Start 24-48 hrs prior to chemotherapy. Isotonic NS or Hypotonic saline if Urine Na 150 meq/L Alkalinization of the urine to pH = 6-7 controversial ! Diuretics controversial ! Mannitol if suboptimal diuresis Avoid P.O. or exogenous K+, potassium sparing diuretics, ACE inhibitors and uric acid tubular re-absorption blockers. Tumor Lysis Syndrome Allopurinol: Xanthine oxidase inhibitor: Xanthine Hypoxanthine Xanthine oxidae -? -ve