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Albuterol
37%
25/67
Allopurinol
12%
8/67
Furosemide
9%
6/67
Rasburicase
22%
15/67
Sodium polystyrene sulfonate
19%
13/67
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This patient undergoing chemotherapy for leukemia now presents with an EKG demonstrating peaked T waves, which suggests the diagnosis of hyperkalemia secondary to tumor lysis syndrome. The best next step in management is acute management with albuterol. Hyperkalemia is seen in tumor lysis syndrome due to the release of large amounts of intracellular electrolytes. Other common electrolyte imbalances associated with tumor lysis syndrome include hyperphosphatemia, hyperuricemia, and hypocalcemia. Hyperkalemia can present with nausea, vomiting, intestinal colic, areflexia, weakness, paresthesias, and an EKG showing peaked T waves, loss of P waves, and/or wide QRS complexes. In addition to calcium gluconate for cardiac stabilization (which will also treat concomitant hypocalcemia), initial management of symptomatic hyperkalemia includes a beta-agonist (e.g., albuterol), insulin and glucose/dextrose, or sodium bicarbonate to temporarily shift potassium into the cells. Figure A demonstrates an EKG with peaked T-waves, which are characteristic of hyperkalemia. Incorrect Answers: Answer 2: Allopurinol can be used as prophylaxis for increased uric acid levels associated with tumor lysis syndrome. However, allopurinol does not reduce pre-existing serum uric acid. Answer 3: Furosemide is a loop diuretic which can be used to remove potassium from the body. In the case of tumor lysis syndrome, there is a risk of increased uric acid levels, which requires IV hydration. Additionally, loop diuretics will not cause an immediate decrease in serum potassium compared to agents that shift potassium intracellularly. Answer 4: Rasburicase can be used to lower serum uric acid in established tumor lysis syndrome. However, for this patient who has EKG changes, hyperkalemia is the most pressing electrolyte imbalance and should be treated emergently. Answer 5: Sodium polystyrene sulfonate can be used to treat hyperkalemia, but it is not appropriate for acute management. Sodium polystyrene sulfonate removes potassium from the body through the gastrointestinal tract. Bullet Summary: Hyperkalemia can be caused by tumor lysis syndrome, and it should be treated acutely with insulin plus glucose or a beta-agonist.
4.3
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