Tumour lysis Syndrome

Question 1

Definition

Answer 1

Severe metabolic disturbance where large quantities of cellular components are released into the blood following lysis of malignant cells

RESULT

• Hyperuricaemia
• Hyperkalaemia
• Hyperphosphataemia
• Hypocalcaemia

Often seen in haemotological malignancies (ALL, burkitt’s)

Question 2

Clinical Features

Answer 2

Seizures
AKI
Cardiac arrhythmia
Death

Question 3

Investigations

Answer 3

uric acid > 475umol/l or 25% increase
potassium > 6 mmol/l or 25% increase
phosphate > 1.125mmol/l or 25% increase
calcium < 1.75mmol/l or 25% decrease

Question 4

Management

Answer 4

Key to management is prevention

Low risk = vigilant monitoring of electrolytes and fluid status

Intermediate risk = 7days allopurinol w/ increased hydration

High risk = 3mg rasburicase along w/ increased hydration

CLINICAL TUMOUR LYSIS
Hydration
Daily rasburicase infusion
IV calcium gluconate
Cardiac monitoring
Dialysis