IBCC Episode 51 - Tumor Lysis Syndrome

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam Thomas discuss Tumor Lysis Syndrome (TLS), covering its signs, symptoms, and relevant physiology, particularly focusing on how xanthine and uric acid cause problems. They delve into the metabolism of purine nucleotides, comparing the use of allopurinol and rasburicase in treatment, advocating for rasburicase when available. The discussion highlights the vicious cycle of renal failure caused by uric acid, xanthine, and calcium phosphate, emphasizing the importance of monitoring calcium and phosphate levels. They identify high-risk patients, such as those with Burkitt's lymphoma or acute leukemia, and discuss the timing of TLS onset. The hosts also cover the diagnosis of TLS using the Cairo definition, differentiating between lab and clinical definitions, and address potential pitfalls in treatment, such as avoiding overcorrection of hypocalcemia and considering early dialysis.