Massive tumour cell breakdown releasing potassium, phosphate and nucleic acids, causing hyperuricaemia and acute kidney injury.
Investigations
- • Potassium, phosphate, calcium, urate, creatinine 6–12 hourly
- • LDH, ECG for hyperkalaemia
- • Urine output monitoring
Management
- • IV fluids 2–3 L/m²/day to maintain high urine output
- • Allopurinol for low/intermediate risk; rasburicase for high risk
- • Treat hyperkalaemia aggressively
- • Avoid calcium unless symptomatic hypocalcaemia
- • Renal replacement if refractory
Clinical pearls
- • Highest risk in Burkitt lymphoma, ALL and bulky high-grade lymphoma
- • Do not alkalinise urine routinely — promotes calcium phosphate deposition
Related in WardRound
Educational — verify locally.
