see: [Dunn - other oncologic emergencies](x-devonthink-item://2CB10C13-DD29-4E8A-A9BF-560FC57E7AB8) > [!key points] > - combination of [[hyperkalemia]], hyperuricaemia, hyperphosphatemia, and [[Hypocalcemia]], often accompanied by [[Acute Renal Failure]] > - tx with IVF and therapies to reverse hyper-k > - hyperuricemia may be prevented with allopurinol or tx with *rasburicase* > - calcium should only be replaced in pts with cardiac or neurologic manifestations of hypocalcaemia (eg seizures) ![[Pasted image 20240821113750.png]] - occurs when destruction of malignant cells occurs so rapidly that body's mechanisms for regulating the unwanted products of their destruction are overwhelmed - patients undergoing *cytotoxic therapy* are particularly at risk for TLS - most common from haematological malignancies: - burkit's lymphoma (hyperuricaemia and LDH 1500 ∝ total tumor burden - [[Leukemia|ALL]] **Risk factors** - large tumor burden / bulky tumour mass - extensive marrow involvement - high tumor sensitivity to chemotherapeutic agents - haematological malignancies eg ALL, Burkitt lymphoma - pre-existing renal failure - glucocorticoids, hormonal agents (lletrozole/ tamoxifen), monoclonal antibiodies (rituximab / gemtuzumab), ionizing radiation - use of chemotherapy eg. cisplatin, etoposide, fludarabine, intrathecal methotrexate, paclitaxel - LDH > 1500 IU - dehydration / volume depletion - pre-treatment hyperuricaemia - pre-treatment hyperphosphataemia - WCC > 50,000 - first chemo dose **Biochemical findings** - [[hyperkalemia]] - hyperphosphataemia → release of intracellular phosphate - hyperuriceamia - [[Hypocalcemia]] → reciprocal from the ↑ PO4 - [[Acute Renal Failure]] / ↑ creatinine and urea - [[Lactic acidosis]] lactic acidosis and dehydration may contribute to the precipitation of uric acid in the renal tubules; ∴ urinalysis may show uric acid crystals. urinary uric acid: urinary creatine ratio is > 1 in pts with acute hyperuricaemic nephropathy **Complications** - AKI - tetany - arrhythmias **Treatments** | tx | mechanism | | ------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------ | | IV hydration | - improve dehydration as cause of renal failure<br>- uric acid excretion | | insulin/dextrose | shift K intracellularly | | beta agonist nebs | shift K intracellularly | | [[Calcium Gluconate]] | replenish Ca in symptomatic (eg [[Seizures]]) ↓ Ca | | rasburicase<br>{recombinant urate oxidase) | enhance uric acid elimination | | [[HCO3 therapy\|sodium bicarb]] | urinary alkalinisation to ↑ uric acid solubility and excretion -- only in presence of of metabolic acidosis<br>- can also help shift K intracellularly | | [[haemodialysis\|dialysis]] | treat [[hyperkalemia\|hyper-K]] and ↑ PO4, support renal f(x) | | allopurinol | decrease uric acid production; pre-treatment | | +/- frusemide | another agent to help clear K in fluid overload |