Hydration Considerations
- Maintaining a high UOP with adequate hydration is the most important factor in preventing TLS.
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- Improves renal perfusion, GFR and minimizes acidosis.
- This prevents precipitation of uric acid and Ca-P crystals.
- Keep an equal fluid balance/prevent volume overload (especially if AKI or cardiac dysfunction):
- Loop diuretics favored, as they promote K excretion.
- AVOID diuretics in hypovolemia or obstructive uropathy.
- Avoid urine alkalinization: Ca-phosphate, xanthine and hypoxanthine (intermediate produces of purine degradation that are increased with allopurinol administration) are poorly soluble in alkalinized urine and may more readily crystallize in a basic environment. Urine alkalinization, as such, lacks efficacy for the prevention of obstructive uropathy in hyperuricemia. It may worsen renal function.
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.
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