80.欲避免或治療前題之狀況，下列處置何者不適當？
(A) sodium bicarbonate tablet 300 mg/tab 3 tablets tid PO
(B) normal saline IV hydration
(C) rasburicase 0.2 mg/kg IV over 30 mins qd x 5 days
(D) allopurinol tablet 100 mg tid PO

NS就有效，bicarb 反而還容易讓 CaP 亂沉澱

The role of urinary alkalinization with either acetazolamide and/or sodium bicarbonate is unclear and controversial. In the past, alkalinization to a urine pH of 6.5 to 7 or even higher was recommended to increase uric acid solubility, thereby diminishing the likelihood of uric acid precipitation in the tubules. However, this approach has fallen out of favor for the following reasons:

●There are no data demonstrating the efficacy of this approach. In addition, the only available experimental study suggested that hydration with saline alone is as effective as alkalinization in minimizing uric acid precipitation.

●Alkalinization of the urine has the potential disadvantage of promoting calcium phosphate deposition in the kidney, heart, and other organs in patients who develop marked hyperphosphatemia once tumor breakdown begins.

UpToDate Tumor lysis syndrome: Prevention and treatment