Which of the following are recommended for management of tumour lysis syndrome? 1. Urinary alkalinization 2. Intravenous fluids 3. Rasburicase 4. Febuxostat Select the correct answer using the code given below.
Tumor Lysis Syndrome Management Recommendations
Tumor Lysis Syndrome (TLS) is a critical condition characterized by the rapid release of intracellular components into the bloodstream following chemotherapy or radiation treatment. Effective management focuses on preventing and treating metabolic abnormalities.
The key management strategies include:
- Intravenous fluids (2): Aggressive hydration with intravenous fluids is fundamental. It helps maintain adequate urine output (aiming for > 0.5-1 mL/kg/hr), promotes the excretion of uric acid and other metabolic byproducts, and helps prevent acute kidney injury.
- Rasburicase (3): This is a recombinant urate oxidase enzyme. It effectively catalyzes the conversion of uric acid into allantoin, a much more water-soluble compound that is readily excreted by the kidneys. It is particularly useful for rapid reduction of significantly elevated uric acid levels.
- Febuxostat (4): This is a non-purine selective inhibitor of xanthine oxidase. By inhibiting this enzyme, it reduces the production of uric acid. It serves as an alternative or adjunct to other therapies for managing hyperuricemia.
Urinary alkalinization (1), while historically used, is generally *not* recommended in current practice guidelines. The risk of calcium phosphate precipitation within the renal tubules, potentially leading to nephrotoxicity, outweighs the benefits for preventing urate nephropathy, especially when other effective measures like hydration and specific medications are available.
Therefore, the recommended management strategies from the list are intravenous fluids, rasburicase, and febuxostat.
The correct option includes items 2, 3, and 4.
Important Questions from General Clinical Conditions
- The height of the Jugular Venous Pulse is determined by :
- The SA node is situated at the junction of:
- Reverse splitting of second heart sound is most commonly seen in :
- A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud diamond-shaped, rough quality systolic murmur best heard at the right $2^{nd}$ intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis ?
Consider the following statements with regard to pulmonary embolism :
1. Unexplained breathlessness is the most common symptom.
2. When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should be considered.
3. Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without obligatory imaging tests.
Which of the statements given above are correct?
