1) For those who feel a sense of anxiety and trepidation during Morning Report teaching sessions, this read from the New England Journal of Medicine is for you!
2) In a recent Morning Report at WCH, we discussed an ambulatory case of Hodgkin’s Lymphoma. Generalized lymphadenopathy and pruritus in the absence of cutaneous abnormalities were the presenting complaints.One potential complication of lymphoproliferative disorders (such as aggressive lymphomas and leukemias) is the tumor lysis syndrome. Release of intracellular contents from rapidly proliferating abnormal white blood cells results in a characteristic set of metabolic derangements that can lead to organ failure and death.
Release of nucleic acids and their subsequent catabolism results in hyperphosphatemia and hyperuricemia. Purine nucleotides are metabolized by xanthine oxidase into uric acid. Both the derangement of calcium-phosphate balance and hyperuricemia contribute to renal impairment though precipitation and crystal deposition. Extracellular release of potassium can also lead to arrhythmias.
Management primarily involves intravenous fluids, prevention of uric acid formation (allopurinol or rasburicase), as well as cardiac monitoring and recurring electrolyte assessment.
- Howard, SC; Jones, DP; Pui, CH. The Tumor Lysis Syndrome. N Engl J Med 2011; 364:1844-1854. FULL ARTICLE