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IM_Quiz_10_answered - P oints A warded Points M issed...

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Points Awarded 2.00 Points Missed 3.00 Percentage 40.0%
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1. A 45-year-old man with non-Hodgkin's lymphoma develops acute renal injury after receiving the first dose of chemotherapy. His vital signs are stable but he has bilateral crackles over the bases of his lungs with trace ankle edema. He has no JVD or gallop and his cardiac examination is normal. Laboratory studies: Serum sodium 132 meq/L Serum potassium 5.9 meq/L Serum chloride 96 meq/L Serum bicarbonate 15 meq/L Creatinine 2.6 mg/dL Serum uric acid 16 mg/dL Phosphate 9.9 mg/dL Blood urea nitrogen 25 mg/dL His urine out put has decreased to 25 cc/hr even with a diuretic. Emergency ultrasound : No evidence of hydronephrosis or obstruction Which of the following is the most appropriate treatment for this patient ? A) Aggressive hydration,high dose furosemide and sodium bicarbonate B) Dialysis C) IV sodium bicarbonate D) Hydration, bicarbonate and allopurinol E) Judicious hydration, bicarbonate and febuxostat Feedback: Tumor lysis syndrome is a very serious and sometimes life-threatening complication of cancer therapy. It can be defined as metabolic abnormalities resulting from spontaneous ( rapid cell turnover tumor) or treatment-related ( most commonly in hematologic and lymphoproliferative malignancies,such as Burkitt lymphoma and T cell acute lympnoblastic leukemia) tumor necrosis or fulminate apoptosis. The metabolic abnormalities are characterized by hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia. These changes can lead to renal injury or some time may be accompanied by coagulopathy. Prevention of this syndrome may be achieved with allopurinol, aggressive volume repletion and alkanlinization of urine. When acute renal injury occurs, obstructive uropathy should be excluded first. The kidney primarily excrete uric aid, phosphorus, and potassium. Uric acid is soluble at physiologic pH, but crystallization tends to occur in acidic environment in renal tubules and collecting ducts. Calcium phosphate is precipitated in the renal tubules and microvasculatures. Mild syndrome can be managed with hydration (answers A), alkalinization with sodium bicarbonate and allopurinol ( answers C&D) but once oliguria occurs, early dialysis is highly recommended. Points Earned: 0.0/1.0 Correct Answer(s):
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  • Spring '10
  • na
  • Cortisol, dexamethasone suppression test, Normal Serum electrolytes, ug Serum ACTH, blood count Normal, normal serum TSH

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