Fluid perfusion monitoring in pediatric AML with tumor lysis syndrome and AKI
DOI: https://doi.org/10.33024/minh.v9i6.4248
Acute Kidney Injury Acute Myeloid Leukemia Tumor Lysis Syndrome
Abstract
Background: Acute Myeloid Leukemia (AML) in children may be accompanied by severe complications, including hyperleukocytosis, Tumor Lysis Syndrome (TLS), and Acute Kidney Injury (AKI), which increase the risk of impaired tissue perfusion, multiorgan dysfunction, and mortality. This combination of complications is rarely reported and requires intensive nursing monitoring to facilitate early detection of clinical deterioration.
Purpose: This case report aims to describe the clinical course and nursing management using a Fluid Perfusion Monitoring Bundle and to formulate monitoring recommendations for similar pediatric onco-hematologic emergencies.
Case Study: A 15-year-old boy was referred with hyperleukocytosis and suspected acute leukemia following progressive weakness, fever, decreased appetite, and weight loss. Laboratory findings revealed a leukocyte count of 118,000/µL, hemoglobin of 5.2 g/dL, platelet count of 87,000/µL, and 74% peripheral blasts, accompanied by hyperuricemia, electrolyte disturbances, and elevated urea and creatinine levels of 194 mg/dL and 4.84 mg/dL, respectively. Immunophenotyping confirmed AML. The patient was diagnosed with AML complicated by hyperleukocytosis, spontaneous TLS, stage 3 AKI, and suspected leukostasis, requiring intensive care in the Pediatric Intensive Care Unit (PICU).
Discussion: Impaired peripheral tissue perfusion was identified as the priority nursing problem due to hyperleukocytosis and leukostasis, further aggravated by severe anemia, TLS, and stage 3 AKI. The Fluid Perfusion Monitoring Bundle, comprising systematic monitoring of hemodynamic status, peripheral perfusion, oxygenation, fluid balance, urine output, renal function, and electrolytes, facilitated early detection of clinical deterioration and supported timely nursing and collaborative interventions.
Conclusion: The Fluid Perfusion Monitoring Bundle supports structured monitoring and early detection of changes in tissue perfusion, fluid balance, and renal function in children with AML, TLS, and stage 3 AKI, thereby contributing to optimized nursing care and the prevention of clinical deterioration.
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