Sun21November0420PM 16

A 31-year-old man undergoes chemotherapy for a non-Hodgkins lymphoma. Following treatment, he develops tumour lysis syndrome (TLS).

Which one of the following is the most characteristic group of metabolic and electrolyte disturbances associated with TLS?

(Please select 1 option)

Hypokalaemia, hyperphosphataemia, hypocalcaemia and hyperuricaemia

Hyperkalaemia, hyperphosphataemia, hypercalcaemia and hyperuricaemia

Hyperkalaemia, hyperphosphataemia, hypocalcaemia and hyperuricaemia Correct

Hypokalaemia, hyperphosphataemia, hypercalcaemia and hypouricaemia

Hyperkalaemia, hypophosphataemia, hypocalcaemia and hypouricaemia

Explanation

Tumour lysis syndrome (TLS) is a group of electrolyte and metabolic disturbances that follow chemotherapy in cancer patients, typically with lymphoproliferative malignancy (non-Hodgkin lymphomas, leukaemia and fast growing solid tumours). TLS usually presents 12-72-hours after chemotherapy but can be a spontaneous occurrence.

The cancer cells lyse and release their contents into the blood.

The metabolic derangements include:

Hyperkalaemia

Hyperphosphataemia

Hypocalcaemia

Hyperuricaemia

High creatinine and urea consistent with renal impairment

Low HCO3 consistent with metabolic acidosis +/- hyperlactaemia

High lactate dehydrogenase (LDH)

Prevention is important (identifying the at risk patient, pre-chemotherapy hydration, electrolyte monitoring and prophylactic allopurinol).

When TLS presents, the management is generally focussed on aggressive hydration, correction of electrolyte disturbance and renal support.

Answer Statistics

1

3%

2

25%

3

70%

4

1%

5

3%

Times answered: 272