SAQ 284 – Oncology – tumour lysis syndrome
Model Answer
Oncology – tumour lysis syndrome.
a. Risk factors
- Large or bulky tumour burden or extensive marrow involvement.
- Highly chemosensitive malignancy, especially ALL or Burkitt lymphoma.
- Pre-existing renal failure or dehydration.
- High pretreatment urate, phosphate, LDH, or WCC.
- First chemotherapy dose or use of high-risk chemotherapy, steroids, monoclonal antibodies, or radiation.
b. Biochemical findings
- Hyperkalaemia.
- Hyperphosphataemia.
- Hyperuricaemia.
- Hypocalcaemia.
- Acute kidney injury with raised urea/creatinine or reduced GFR.
c. Treatment
| Treatment | Mechanism / rationale |
|---|---|
| IV hydration | Corrects dehydration, supports renal function, and increases urate excretion. |
| Insulin with dextrose or beta-agonist | Shifts potassium intracellularly. |
| Phosphate binder | Binds phosphate in the gut and reduces absorption. |
| Calcium gluconate | Replenishes calcium in symptomatic hypocalcaemia, including seizure. |
| Rasburicase | Enhances uric-acid elimination. |
| Allopurinol | Reduces uric-acid production. |
| Renal replacement therapy | Treats severe hyperkalaemia, hyperphosphataemia, and renal failure. |
| Sodium bicarbonate when acidotic | Shifts potassium intracellularly and increases urate solubility/excretion. |
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