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Metabolic Emergencies in Oncology

  • Chapter
Oncology

Abstract

Tumor lysis syndrome (TLS) refers to the constellation of electrolyte abnormalities that occur as a result of the rapid and immediate release of intracellular contents into the bloodstream. The syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia (Table 72.1). Metabolic acidosis and acute renal failure may also occur. The release of intracellular potassium and organic, as well as inorganic, phosphate into the bloodstream from cells undergoing apoptosis, results in the development of hyperkalemia and hyperphosphatemia, respectively. Prolonged and severe hyperphosphatemia may result in a marked decrease of the serum calcium concentration, but symptomatic hypocalcemia rarely develops. It is the rapid breakdown of nucleic acids that leads to hyperuricemia. TLS may develop before the administration of chemotherapy in patients with rapidly proliferating hematologic neoplasms; however, TLS usually occurs after the administration of high doses of chemotherapy, which results in the rapid destruction of tumor cells.

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  1. Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Daniel J. De Angelo MD, PhD (Assistant Professor)

  2. Adult Leukemia Program, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, MA, USA

    Daniel J. De Angelo MD, PhD (Assistant Professor)

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  2. Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Daniel F. Hayes MD (Clinical Director) (Clinical Director)

  3. Department of Cardiothoracic Surgery, New York University School of Medicine and Comprehensive Cancer Center, New York, NY, USA

    Harvey I. Pass MD (Professor and Chief of Thoracic Surgery and Head) (Professor and Chief of Thoracic Surgery and Head)

  4. Thoracic Oncology, New York University School of Medicine and Comprehensive Cancer Center, New York, NY, USA

    Harvey I. Pass MD (Professor and Chief of Thoracic Surgery and Head) (Professor and Chief of Thoracic Surgery and Head)

  5. Department of Medicine, Harvard Medical School, USA

    Richard M. Stone MD (Associate Professor and Clinical Director) (Associate Professor and Clinical Director)

  6. Adult Leukemia Program, Dana-Farber Cancer Institute, Boston, MA, USA

    Richard M. Stone MD (Associate Professor and Clinical Director) (Associate Professor and Clinical Director)

  7. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, USA

    Patricia A. Ganz MD (American Cancer Society Clinical Research Professor, Director and Professor) (American Cancer Society Clinical Research Professor, Director and Professor)

  8. Schools of Public Health and Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Patricia A. Ganz MD (American Cancer Society Clinical Research Professor, Director and Professor) (American Cancer Society Clinical Research Professor, Director and Professor)

  9. Department of Radiation Oncology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA

    Timothy J. Kinsella MD (Vincent K. Smith Professor and Chairman) (Vincent K. Smith Professor and Chairman)

  10. Department of Medicine, University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA

    Joan H. Schiller MD (Melanie Heald Professor of Medical Oncology) (Melanie Heald Professor of Medical Oncology)

  11. Health Media Research Laboratory, Department of Health Behavior and Health Education, University of Michigan School of Public Health, USA

    Victor J. Strecher PhD, MPH (Professor and Director and Associate Director) (Professor and Director and Associate Director)

  12. Cancer Prevention and Control, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Victor J. Strecher PhD, MPH (Professor and Director and Associate Director) (Professor and Director and Associate Director)

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De Angelo, D.J. (2006). Metabolic Emergencies in Oncology. In: Chang, A.E., et al. Oncology. Springer, New York, NY. https://doi.org/10.1007/0-387-31056-8_72

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