High risk malignancies for Tumor Lysis Syndrome include AML, ALL, CML, Burkitt Lymphoma, non- Hodgkins Lymphoma

Patients present with metabolic derangements:

• Hyperkalemia
• Hyperphosphatemia
• Hypocalcemia - paresthesias, tetany, + Chvostek and Trousseau, bronchospasm, seizure
• Hyperuricemia -  lethargy, nausea, vomiting, renal colic
• Elevated LDH
• Metabolic acidosis
• Renal insufficiency
• Various arrhythmias

Diagnostic Criteria

Cairo-Bishop Classification

-Laboratory Tumor Lysis:  2 or more of the following 3 days before or 7 days after chemotherapy

• uric acid > 8 mg/dL or 25% increase
• potassium > 6 meq/L or 25% increase
• phosphate > 4.5 mg/dL or 25% increase
• calcium < 7 mg/dL or 25% decrease

-Clinical Tumor Lysis: Laboratory tumor lysis + one of the below

• Renal failure
• Cardiac arrythmias
• Seizure

General management

• Treat metabolic derangements and stabilize!
• Support renal failure
• IV hydration
• Ultimately, if all else fails, dialysis

Hyperuricemia (2/2 increased purine metabolism from cell turnover)

• uric acid accumulates in the kidney and leads to renal failure
• Allopurinol, rasburicase, dialysis
• urinary alkalization with sodium bicarbonate to promote excretion

 Hyperkalemia

• Treat with the “usual stuff”
• calcium gluconate, insulin/glucose, albuterol, dialysis

Hypocalcemia

• Treat only if symptomatic with calcium gluconate
• risk of precipitating with phosphate, causing worsening renal failure

References

1. https://lifeinthefastlane.com/ccc/tumour-lysis-syndrome/

2.  http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1759&Sectionid=128948955#1137331619