Forty-eight hours after starting chemotherapy for Burkitt lymphoma, a 24-year-old man develops potassium of 6.8 mmol/L, uric acid of 18 mg/dL, phosphate of 8 mg/dL and calcium of 6.5 mg/dL, with a creatinine rise. The immediate management priority is:

• A Aggressive intravenous hydration with rasburicase and cardiac monitoring ✓
• B Oral allopurinol and sodium bicarbonate infusion alone
• C Haemodialysis as first line before any other measure
• D Intravenous calcium gluconate to correct hypocalcaemia

Explanation

Tumour lysis syndrome from rapid cell breakdown produces hyperkalaemia, hyperphosphataemia, hyperuricaemia, hypocalcaemia and acute kidney injury. Management begins with aggressive volume expansion, rasburicase for marked hyperuricaemia, and continuous cardiac monitoring for arrhythmia risk. Allopurinol alone is inadequate at this severity, dialysis is reserved for refractory hyperkalaemia or oliguria, and giving IV calcium risks calcium phosphate deposition when phosphate is already high.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.