TLS and choice of fluid in initial phase

Q: Lactate Ringer's (LR) is the fluid of choice in initial resuscitation of Tumor Lysis Syndrome (TLS)? 

A) True

B) False

Answer: B

Ringer's Lactate, named after its inventor, is also known as Lactate Ringer or LR. It contains sodium, chloride, potassium, calcium, and lactate. Due to its more isotonic sodium content than normal saline (NS), it is now considered a primary fluid for resuscitation in the ICU. 

In TLS, LR may worsen hyperkalemia and hyperphosphatemia with calcium phosphate precipitation once the tumor breaks down. 

NS stays the fluid of choice, at least in the initial phase of TLS management.

#oncology

#electrolytes

References:

1. Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26:2767.

2. Mirrakhimov AE, Voore P, Khan M, Ali AM. Tumor lysis syndrome: A clinical review. World J Crit Care Med. 2015 May 4;4(2):130-8. doi: 10.5492/wjccm.v4.i2.130. PMID: 25938028; PMCID: PMC4411564.

3. McBride A, Trifilio S, Baxter N, Gregory TK, Howard SC. Managing Tumor Lysis Syndrome in the Era of Novel Cancer Therapies. J Adv Pract Oncol. 2017 Nov-Dec;8(7):705-720. Epub 2017 Nov 1. PMID: 30333933; PMCID: PMC6188097.