Tumor Lysis Syndrome

Dissolved

Step 1: View clinicals

A 14 year old boy presents with nausea, vomiting and malaise for 2 days. There was no history of fever or system specific symptoms. His medical history is significant for mild intermittent asthma since age 8. He visited his primary care practitioner 5 days ago with an exacerbation, which was treated with oral prednisolone for 3 days. A FBC is within normal limits, but a serum electrolyte assay reveals a potassium level of 6.0 mEq/L; this is repeated and re-confirmed. An ECG is found to be completely normal. His random capillary glucose is 120 mg/dl.


Step 2: Order all relevant investigations

Renal Functions + Urinalysis

Urea: 25 mg/dL (7 - 30) Creatinine: 0.7 mg/dL (<1.2) eGFR (Schwartz): 94.4 ml/min/1.73 m2 Urinalysis: no abnormalities

Arterial Blood Gases

pH: 7.38 (7.35 - 7.45) paCO2: 40 mmHg (35 - 45) paO2: 90 (> 75 on room air) HCO3: 23 mmol/L (22 - 26) ABE: -1.7 (-2 to +2)

Ca++, PO4---, Uric Acid

Ca++: 6.0 mg/dl (8.5 - 10.3) PO4---: 8.2 mg/dl (3.5 - 5) Uric Acid: 15 mg/dl (4.0 - 8.5)

CPK

CPK: 30 U/L (22 - 198)


Step 3: Select appropriate management

Nebulize with Salbutamol
Rasburicase
Calcium Gluconate
High-Dose Corticosteroids


Score: ★★☆