Life-threatening syndrome of hyperuricemia and electrolyte abnormalities caused by sudden, massive cellular lysis that sometimes follows initiation of treatment for hematologic malignancies
Clinical Manifestations
Symptoms relate to underlying electrolyte abnormalities
Nausea, vomiting, diarrhea, anorexia, lethargy, hematuria, heart failure, cardiac dysrhythmias, seizures, muscle cramps, tetany, syncope, and possible sudden death
Investigations
Labs
Hyperkalemia ≥6 or 25% above baseline
Hyperphosphatemia ≥1.45 in adults (of ≥2.1 in children) or 25%
Hypocalcemia ≤1.75 or 25% below baseline
Hyperuricemia ≥476 or 25% above baseline
High LDH
Elevated creatinine
Classification (Cairo-Bishop)
Laboratory TLS
Any two or more abnormal serum values:
Uric acid ≥476 umol/L or 25% above baseline
Potassium ≥6 mmol/L or 25% above baseline
Phosphorus ≥1.45 mmol/L or 25% above baseline
Calcium ≤1.75 mmol/L or 25% below baseline
Present within 3 days before or 7 days after instituting chemotherapy
In the setting of adequate hydration (with or without alkalinization) and use of a hypouricemic agent
Clinical TLS (CTLS)
Laboratory TLS plus one or more of the following:
Increased serum creatinine concentration (≥1.5 times the upper limit of normal [ULN])
Cardiac arrhythmia/sudden death
Seizure
Management
Acute
Allopurinol
Rasburicase preferred in renal failure
Lots of IV fluids
Monitor potassium closely
Prevention
Allopurinol preferred to rasburicase at a dose of 100 mg/m^2^ q8h
