So welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas, and we're going to talk about tumor lysis syndrome.

Tumorlysis syndrome. You go zero to 100 right away. It's a lot of fun to treat because the patients can be super, super sick. And then if you approach it in a correct manner, they can turn around

within your shift, shall we say, hey, Josh?

Today we're going to talk about the signs and symptoms.

We're going to get specific with relevant physiology of why these xanthine and uric acid cause

all the trouble.

And then Josh has wonderfully mapped out the approach to clinical signs, the diagnosis, and

the standard textbook

BS doesn't work. So he's using the chiro definition, which I totally agree with. It's a lot

easier to use. And then we'll cover prevention and then treatment of tumor lysis syndrome.

So that being said, Josh, let's get right into it because this one will be a quick to the point

podcast. All right. So we're going to start with some physiology, and it's not super exciting,

but it's incredibly important to understand how these drugs are working and when we're

going to choose with different drugs.

So essentially, tumor Lysis syndrome results from lysis of a lot of tumor cells, which

releases calcium, phosphate, potassium, and predominantly purine nucleotides.

So what I want to talk about right now is how these purine nucleotides. So what I want to talk about right

now is how these purine nucleotides are metabolized. So aden and guanine are essentially

shunted through to generate xanthene, and then finally yurk acid, and then in other mammals,

not in humans, yurk acid can be metabolized into Aalentohone, which is totally harmless. The problem arises

when yuracid and xanthine can precipitate the kidneys and cause problems. Now, traditionally,

alipurinol has been used to block off this channel, and alipurininin inhibits the conversion

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