HAEM/ONC
TUMOUR LYSIS SYNDROME
oncological emergency due to turnover of high cell mass malignancies resulting in severe metabolic derangement - LITFL
PromptRisk factors for tumour lysis syndrome
ResponseHigh tumour proliferation rates (Burkitt lymphoma, ALL, Lymphoblastic lymphoma, Diffuse large cell lymphoma, Solid tumours with high proliferation rate)
Large tumour burdon
Sensitivity to chemotherapy
Hamatological malignancy
Bulky disease >10cm diameter0
Leukocytosis >25
Pre-existing renal impairment
Pre-existing hyperuricemia
Dehydration
Large tumour burdon
Sensitivity to chemotherapy
Hamatological malignancy
Bulky disease >10cm diameter0
Leukocytosis >25
Pre-existing renal impairment
Pre-existing hyperuricemia
Dehydration
PromptMetabolic features of tumour lysis syndrome
ResponseRenal impairment
Hyperuricaemia
Hyerkalaemia
Hyperphosphataemia
Hypocalcaemia
Lactic acidosis
Metabolic acidosis
High LDH indicative of high cell turnover
Hyperuricaemia
Hyerkalaemia
Hyperphosphataemia
Hypocalcaemia
Lactic acidosis
Metabolic acidosis
High LDH indicative of high cell turnover
PromptManagement of TLS
ResponseHydration +/- diuresis
- Agressive IV up to 3L
- Aim UO 2 mL/kg/h
- Allopurinol up to 800 mg/day (or rasburicase)
- K - Calcium gluconate, insulin/glucose, resonium
- Phosphate >1.45 - phosphate binders, dialysis
- Treat hypocalcaemia only in symptomatic patients(muscle cramps, tetany, arrhythmias, seizures, hyperkalaemia) - risk of precipitation with PO4)
- ?dialysis if severe renal failure, uraemic, encephalopathic/pericarditis, refractory acidosis or refractory hyperkalaemia