Ms. Zhang is a patient with small cell lung cancer. CT revealed that the abdominal lymph nodes, supraclavicular lymph nodes and adrenal glands had metastasized. Considering the high degree of malignancy of SCLC, Ms. Zhang underwent chemotherapy immediately after diagnosis.
On the second day of chemotherapy, Ms. Zhang found that the lymph nodes on her neck that could be touched before were almost invisible. She was ecstatic with such a good effect.
However, on the third day, Ms. Zhang developed nausea , vomiting, abdominal pain, and weakness of the legs to walk. She believed that her white blood cells had decreased. The doctor checked her blood routine and kidney function urgently, and found that the white blood cells were not low, but the kidney function was abnormal, the serum potassium and phosphorus were high, the renal function was insufficiency, and the uric acid was much higher than before chemotherapy. Tumor lysis syndrome, and issued a critical illness notice to the family.
Chemotherapy works so well, but this danger occurs Complications of life – tumor lysis syndrome!
What is Tumor Lysis Synthesis sign?
In layman’s terms , that is, a large number of cancer cells are rapidly killed. After cancer cells die, a large number of intracellular electrolytes and other metabolites enter the blood, and the kidneys are too late to excrete and are overwhelmed. Renal function and electrolyte abnormalities.
A tumor shrinking too quickly is sometimes not a good thing.
Tumor lysis syndrome belongs to cancer patients emergency, once it occurs, emergency treatment is required, otherwise it may be life-threatening.
Tumor lysis syndrome often occurs in hematological tumors, Patients with rapidly growing tumors and those with tumors that are highly sensitive to treatment. For example: non-Hodgkin’s lymphoma, small cell lung cancer, acute leukemia, etc., most of which occur 48-72 hours after chemotherapy.
After chemotherapy drugs enter the body, the Dying, cell walls break down, and they release substances like potassium, phosphorus, proteins, and nucleic acids. Nucleic acids are further broken down into uric acid. Hyperuricemia can lead to renal failure, which may exacerbate the associated hyperkalemia.
Therefore, the typical laboratory findings of tumor lysis syndrome are < strong>Three highs and one low, renal failure. “Three highs and one low” refers to hyperkalemia, hyperuricemia, hyperphosphatemia and hypocalcemia.
Hyperkalemia can affect cardiac conduction, leading to arrhythmias and cardiac arrest. Hyperphosphatemia can cause neuromuscular irritation and seizures. Hyperphosphatemia can also lead to hypocalcemia, which in turn can lead to convulsions, seizures, and cardiac arrhythmias.
The patient’s main symptoms are nausea, vomiting, and lethargy , chest tightness, shortness of breath, loss of appetite, arrhythmia, decreased urine output, edema, muscle cramps, etc.
Prevention is the best way to reduce tumor lysis syndrome mortality strong>
raise awareness before chemoradiotherapy strong>, for tumors sensitive to radiotherapy and chemotherapy, the possibility of tumor cell lysis syndrome should be considered.
Enhanced hydration during chemotherapy to ensure sufficient fluid intake to ensure renal perfusion. Diuretics are added after chemotherapy to promote the excretion of products after tumor cell necrosis.
Intensified monitoring throughout chemotherapy, such as close monitoring24 Hourly urine output, renal function, and electrolytes. Once hyperkalemia occurs, diuresis should be performed quickly, and dialysis can be used if necessary.
Although tumor lysis syndrome is critical, Sufficient experience, early prevention, early identification, and emergency treatment can save the patient’s life to the greatest extent possible.