A client is receiving chemotherapy for acute myeloid leukemia. The health care provider prescribes allopurinol to prevent tumor lysis syndrome (TLS). Which laboratory value indicates a therapeutic response to the medication?

Question

A client is receiving chemotherapy for acute myeloid leukemia.  The health care provider prescribes allopurinol to prevent tumor lysis syndrome (TLS).  Which laboratory value indicates a therapeutic response to the medication?

Quizplus · Accepted Answer

11ecbb05_cc84_ab51_b433_55199b67a01d_MD0009_00 A potential complication of chemotherapy is acute tumor lysis syndrome (TLS), a rapid release of intracellular components into the bloodstream. Massive cell lysis releases intracellular ions (potassium and phosphorus) and nucleic acids into the bloodstream. Catabolism of the nucleic acids produces uric acid, resulting in severe hyperuricemia. Released phosphorus binds calcium, producing calcium phosphate mixture but lowering serum calcium levels. Both calcium phosphate and uric acid are deposited into the kidneys, causing renal injury. Allopurinol (Zyloprim) blocks the nucleic acid catabolism and prevents hyperuricemia but would not affect potassium, phosphate, and calcium levels. Chronic gout and uric acid calculi also require the administration of allopurinol to decrease uric acid accumulation. A normal blood uric acid level for an adult male is 4.4-7.6 mg/dL (262-452 µmol/L) and female is 2.3-6.6 mg/dL (137-393 µmol/L). (Option A) The normal calcium level for adults is 8.6-10.2 mg/dL (2.15-2.55 mmol/L). The client with this complication would experience hypocalcemia. (Option B) The normal phosphate level for adults is 2.4-4.4 mg/dL (0.78-1.42 mmol/L). In this condition, the phosphate level would show hyperphosphatemia. (Option C) The normal potassium level for adults is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). Hyperkalemia is usually present in a client with this chemotherapy-induced complication. Educational objective: The therapeutic effect of allopurinol (Zyloprim) is to decrease hyperuricemia caused by TLS. Laboratory values of significance in TLS include rising blood uric acid, potassium, and phosphate levels, with decreasing calcium levels.

A Client Is Receiving Chemotherapy for Acute Myeloid Leukemia