Question

A 7 – year old boy presented with abdominal pain, vomiting, oliguria, and periorbital puffiness following chemotherapy. Investigations reveal hyperuricemia, raised creatinine levels, and hyperkalemia. What is the next best step in the management of this condition ?

• A. Hydration
• B. Probenecid
• C. Allopurinol
• D. Rasburicase

Answer 1

The Correct Option is A

The case presented involves a 7-year-old boy who is likely experiencing tumor lysis syndrome (TLS) following chemotherapy. TLS is characterized by the rapid release of intracellular components into the bloodstream, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia. The primary goal in managing TLS is to prevent renal failure and stabilize the patient.

Step-by-Step Management:

1. Initial Assessment:
   • Confirm the diagnosis of TLS based on laboratory findings such as hyperuricemia, elevated creatinine, and hyperkalemia.
2. Immediate Management:
   • Hydration: The first and most crucial step is aggressive intravenous hydration. This dilutes the serum electrolytes, aids in renal perfusion, and promotes the excretion of uric acid and phosphates.
3. Addressing Hyperuricemia:
   • Allopurinol or Rasburicase may be administered to further control uric acid levels. Allopurinol inhibits the formation of uric acid, while Rasburicase breaks down uric acid to soluble allantoin. However, these are secondary to hydration in acute management.
4. Monitoring and Follow-up:
   • Continuous monitoring of renal function, electrolytes, and fluid balance is essential to detect and address any complications promptly.

In this scenario, the next best step in management considering the symptoms and lab findings is hydration, which is crucial in the initial management of TLS to prevent further renal complications.