What is included in metabolic management of pediatric acute myelocytic leukemia (AML)?

Updated: Sep 12, 2017
  • Author: Mark E Weinblatt, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Patients who present with a large leukemic cell burden, either a high circulating WBC count or massive organomegaly, are at risk for severe, often life-threatening metabolic derangements.

Before beginning cytoreduction, correct any existing abnormalities and take measures to prevent new ones.

Hyperkalemia and hyperphosphatemia with associated hypocalcemia result from rapid cell turnover and destruction.

Promptly treat elevated potassium levels by using measures such as sodium polystyrene sulfonate (Kayexalate), an insulin and glucose combination, and, sometimes, hemodialysis.

Calcium replacement is often necessary to correct severe hypocalcemia.

Prevention is key to avoiding most serious metabolic complications. The combination of vigorous hydration, administration of allopurinol (a xanthine oxidase inhibitor to prevent the formation of uric acid), and alkalinization of the urine with sodium bicarbonate is usually successful in preventing serious tumor lysis syndromes. For patients at high risk for tumor lysis syndrome, those with renal dysfunction, or those whose uric acid levels are already elevated, rasburicase directly lyses uric acid and can rapidly reduce its levels.


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