CORRESPONDENCE Tumor Lysis Syndrome : Correspondence Vineeta Gupta & Sanjeev Kumar Gupta Received: 6 March 2013 / Accepted: 10 April 2013 # Dr. K C Chaudhuri Foundation 2013 To the Editor: We read with interest the management protocol on Tumor lysis syndrome [1] by Rajendran et al. The guide- lines are lucid and will be helpful in managing a com- mon emergency in children with malignancies. However, there are a few points which need clarification: Firstly, what should be the choice of fluid for hyper- hydration? The article mentions only “saline dextrose”. Is it dextrose normal saline (DNS), N/2 D 5 or N/4 D 5 ? Secondly, does serum lactic dehydrogenase level (LDH) have any relevance in the risk stratification of tumors on the basis of potential for tumor lysis syndrome as mentioned in some studies [2]? Thirdly, what should be the duration of alkalinization if it is considered for a patient with hyperuricemia who is unable to afford Rasburicase? Financial constraints limit the use of Rasburicase in large number of patients in our setup. Lastly, can we grade the severity of tumor lysis syndrome (TLS) based on biochemical parameters? References 1. Rajendran A, Bansal D, Marwaha RK, Singhi SC. Tumor lysis syndrome. Indian J Pediatr. 2013; 80: 50-4. 2. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011; 364: 1844-54. V. Gupta (*) Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India e-mail: [email protected] S. K. Gupta Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India Indian J Pediatr DOI 10.1007/s12098-013-1048-1

Tumor Lysis Syndrome : Correspondence

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CORRESPONDENCE

Tumor Lysis Syndrome : Correspondence

Vineeta Gupta & Sanjeev Kumar Gupta

Received: 6 March 2013 /Accepted: 10 April 2013# Dr. K C Chaudhuri Foundation 2013

To the Editor:We read with interest the management protocolon Tumor lysis syndrome [1] by Rajendran et al. The guide-lines are lucid and will be helpful in managing a com-mon emergency in children with malignancies. However,there are a few points which need clarification:

Firstly, what should be the choice of fluid for hyper-hydration? The article mentions only “saline dextrose”. Is itdextrose normal saline (DNS), N/2 D5 or N/4 D5? Secondly,does serum lactic dehydrogenase level (LDH) have anyrelevance in the risk stratification of tumors on the basisof potential for tumor lysis syndrome as mentioned insome studies [2]? Thirdly, what should be the duration of

alkalinization if it is considered for a patient with hyperuricemiawho is unable to afford Rasburicase? Financial constraints limitthe use of Rasburicase in large number of patients in our setup.Lastly, can we grade the severity of tumor lysis syndrome(TLS) based on biochemical parameters?

References

1. Rajendran A, Bansal D, Marwaha RK, Singhi SC. Tumor lysissyndrome. Indian J Pediatr. 2013; 80: 50-4.

2. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl JMed. 2011; 364: 1844-54.

V. Gupta (*)Department of Pediatrics, Institute of Medical Sciences,Banaras Hindu University, Varanasi 221005, Uttar Pradesh, Indiae-mail: [email protected]

S. K. GuptaDepartment of Surgery, Institute of Medical Sciences,Banaras Hindu University, Varanasi, Uttar Pradesh, India

Indian J PediatrDOI 10.1007/s12098-013-1048-1