Q: Which Diuretic is preferred in patients with Tumor Lysis Syndrome if required? (select one)
Patients undergoing TLS usually don't require diuretics and intravenous hydration should be enough. But a large number of chemotherapy patients have either cardiac or/and renal dysfunction and may require diuretics to keep urine output (U-OP) 80-100 cc/hour, a usual target of U-OP in TLS. Loop diuretics (furosemide) is preferred as it also helps to reduce the risk of hyperkalemia by increasing potassium excretion. TLS is considered an oncologic emergency. ICU admission is highly desirable. It releases a large amount of potassium, phosphate, and nucleic acids (subsequently converted to uric acid) into the systemic circulation.
Reference:1. Mirrakhimov AE, Voore P, Khan M, Ali AM. Tumor lysis syndrome: A clinical review. World J Crit Care Med. 2015;4(2):130-138. Published 2015 May 4. doi:10.5492/wjccm.v4.i2.130 2.