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http://ccsa.edu.sv/study.php?online=where-can-i-get-help-writing-a-speech where can i get help writing a speech A normalized for 70-kg patient or body surface area = 1. 73 m2. All costs are estimated and may vary. From yim bt, sims-mccallum rp, chong ph. Rasburicase for the treatment and prevention of hyperuricemia. Ann pharmacother. 2003;37:1047–1054. Chapter 99  |  supportive care in oncology  1487 clinical presentation and diagnosis of tls38 general •• patients present primarily with laboratory abnormalities. •• normal uric acid is equal to 2 to 8 mg/dl (119–476 μmol/l). •• most often occurs within 12 to 72 hours of initiation of cytotoxic therapy signs and symptoms •• most patients are asymptomatic •• patients may develop edema, fluid overload, and oliguria, which may progress to anuria with acute renal failure •• some patients with hyperuricemia may have nausea, vomiting, and lethargy •• hyperkalemia. Lethargy, muscle weakness, paresthesia, ecg changes, bradycardia •• hypocalcemia. Muscle cramps, tetany, irritability, paresthesias, arrhythmias laboratory tests (adults) •• serum uric acid level greater than 8 mg/dl (476 μmol/l) •• serum potassium greater than 6 meq/l (6 mmol/l) •• serum phosphorus greater than 4. 5 mg/dl (1. 45 mmol/l) •• serum calcium less than 7 mg/dl (1. 75 mmol/l) •• elevated blood urea nitrogen and creatinine once renal dysfunction develops or •• a change of greater than 25% from baseline in the above laboratory values35 patient care process. Tls patient assessment. •• assess patient’s medical history for risk factors of tls, including cancer and chemotherapy history. •• assess patient for signs/symptoms of tls, including uremia, visual disturbances, muscle cramping, etc. •• order laboratory tests. Uric acid, potassium, phosphate, calcium, electrolytes, renal function tests. Therapy evaluation. •• monitor daily at-risk patients who present with normal laboratory values daily for serum uric acid, electrolytes (na, k, ca, mg, cl, po4), blood urea nitrogen, creatinine, and urine output. •• monitor for signs of fluid overload during aggressive hydration. Care plan development. •• initiate allopurinol follow-up evaluation. •• continue hydration and prophylaxis until 2 to 3 days after cytotoxic therapy.

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