Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Tumor Lysis Syndrome

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In one line

·Cancer treatment kills millions of cancer cells so fast that the kidneys cannot clear all the stuff they dump into the blood.

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Normal physiology

·Every cell in the body holds potassium, phosphate, and DNA building blocks locked inside. When a cell dies naturally, it breaks open gently and releases tiny amounts of these chemicals into the blood. The kidneys filter them out and send them into the urine. The parathyroid glands (four tiny glands in the neck) and kidneys together keep calcium and phosphate balanced in the blood so muscles and nerves work smoothly.

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What goes wrong

·When chemotherapy, steroids, or targeted cancer drugs hit a bulky cancer — especially fast-growing blood cancers like Burkitt lymphoma, acute lymphoblastic leukemia, or acute myeloid leukemia — millions of cancer cells die within hours. Each cell bursts like a tiny water balloon, dumping all its potassium, phosphate, and DNA pieces into the blood at the same moment. The kidneys try to filter it all out, but the flood is too big and too fast. Potassium stacks up and stops the heart's rhythm. Phosphate grabs onto calcium and hides it, leaving the blood calcium dangerously low. The liver turns the DNA pieces into uric acid, which forms sharp crystals that clog the kidney tubes like sand blocking a drain, and the kidneys start to fail.

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Hallmark signs

·Fast or skipping heartbeat (arrhythmia)
·Muscle stiffness, cramps, or twitching (tetany)
·Seizures
·Peeing very little or not at all (acute kidney injury)
·Nausea, vomiting, or diarrhea
·Feeling very tired and weak
·Confusion or feeling 'out of it'
·Flank pain (pain in the sides of the back, near the kidneys)

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Red flags · escalate now

·Heart rhythm suddenly becomes very slow, very fast, or stops (from dangerously high potassium)
·Urine output drops to almost nothing within hours of starting cancer treatment
·Seizure or severe muscle spasms (tetany) that won't stop

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Workup

·Basic metabolic panel (BMP) with calcium and phosphate
·Serum uric acid
·Lactate dehydrogenase (LDH)
·Urinalysis with microscopy
·Electrocardiogram (EKG)
·Repeat BMP with calcium, phosphate, uric acid, and LDH every 4–6 hours during the first 24–48 hours after starting cancer therapy

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Treatment

·Aggressive IV hydration with normal saline at 200–250 mL/m² per hour (about 3 L/m² per day) to keep urine output at least 80–100 mL/m² per hour
·Rasburicase (a recombinant enzyme) for high-risk patients, or allopurinol for low-to-intermediate risk, to lower uric acid
·Treat high potassium (hyperkalemia) with IV calcium gluconate (if EKG shows dangerous changes), insulin + dextrose (glucose), inhaled beta-agonists (albuterol), and oral or rectal potassium binders (sodium polystyrene sulfonate, patiromer)
·Oral phosphate binders (sevelamer or lanthanum carbonate, NOT calcium-based if phosphate is very high) and avoid giving IV calcium until phosphate drops below 6 mg/dL
·Continuous heart (cardiac) monitoring on telemetry and urgent hemodialysis if potassium > 6.5 mEq/L despite treatment, phosphate > 10 mg/dL, severe symptoms (seizure, dangerous heart rhythm), or acute kidney injury with rising creatinine and low urine output
·Hold or reduce the dose of the next round of chemotherapy if tumor lysis syndrome is severe and not controlled

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NCLEX trap

·When phosphate is sky-high (like it is in tumor lysis syndrome), giving calcium makes calcium and phosphate lock together like puzzle pieces — and those clumps get stuck in the kidneys, wrecking them even more. Lower the phosphate first with binders, treat the root cause (IV fluids, rasburicase to break down uric acid), and only give calcium if the patient is seizing or the heart is stopping.
·That was the old teaching — but we stopped doing it because making urine basic (alkaline) causes calcium and phosphate to clump together even faster, blocking the kidneys. Instead, give rasburicase (a medicine that chops uric acid into something the kidneys can clear easily) and flood the patient with IV fluids.
·Tumor lysis syndrome is a race against time. Start IV fluids right away at 3 liters per square meter of body surface per day — even before the lab results come back. Fluids wash out the cell debris and protect the kidneys. The labs confirm what you already suspect, but waiting for them wastes precious time.
·Tumor lysis syndrome can strike any patient — child or adult — who has a big, fast-growing cancer that responds well to treatment. The highest-risk tumors are Burkitt lymphoma, acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and bulky non-Hodgkin lymphoma. It can happen after chemo, steroids, rituximab, or even a single dose of cytarabine. Know the risk.
·All the lab chaos comes from one upstream break: cancer cells are dying too fast, dumping potassium, phosphate, and uric acid into the blood all at once. Fix the break first — flood the patient with IV fluids, give rasburicase to clear uric acid, and let the kidneys catch up. The abnormalities will improve together.

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