Tumour Lysis SyndromeEmergency

Day 2 after first chemo for Burkitt lymphoma — K⁺ 6.4, phosphate 2.8, creatinine doubling. Cell death is flooding the blood: fluids, rasburicase, treat the potassium.

• K⁺ ≥6.0, peaked T waves
• Tetany, seizures, QT prolongation
• Urine output <0.5 mL/kg/h
• High-risk tumour starting chemo without prophylaxis

• Pre-renal AKI from dehydration
• Sepsis with AKI
• Obstructive uropathy
• Contrast nephropathy

• Prevention: Fluids + allopurinol (intermediate) / rasburicase (high-risk) BEFORE chemo
• ICU: K⁺ ≥6, ECG changes, oliguria, or established TLS with AKI
• Dialysis: Refractory hyperK⁺, symptomatic hypoCa²⁺, overload, acidosis

• Prevention beats rescue: hydrate + risk-stratify BEFORE the first chemo dose
• Rasburicase degrades uric acid in the sample tube — pink-top on ice or don't bother rechecking
• Symptomatic hypocalcaemia is the ONLY reason to give calcium in TLS

• Put potassium or calcium in maintenance fluids
• Give rasburicase in G6PD deficiency — fatal haemolysis/methaemoglobinaemia
• Alkalinise the urine — promotes calcium-phosphate precipitation in tubules

• Forgetting G6PD before rasburicase
• Rechecking uric acid after rasburicase
• Diuretics to 'force' urine in a dehydrated patient
• Stopping at normal K⁺ while phosphate climbs

ICU/HDU until metabolically stable ×24–48 h; renal follow-up; coordinate chemo timing with oncology once cleared.