A patient with high-grade lymphoma starts chemotherapy and soon has potassium 6.5 mmol/L, phosphate 2.8 mmol/L, calcium 1.7 mmol/L and a rising urate and creatinine. What is the diagnosis and prevention?
Answer and explanation
Correct answer: D. Tumour lysis syndrome, prevented with hydration and rasburicase
- Step 1: Rapid cell death releases intracellular potassium, phosphate and nucleic acids. Step 2. This produces hyperkalaemia, hyperphosphataemia, hypocalcaemia and hyperuricaemia, so hydration and urate-lowering therapy are given before chemotherapy. Answer: Tumour lysis syndrome, prevented with hydration and rasburicase. Why not the others: Calcium is low rather than raised. SIADH causes hyponatraemia. SVC obstruction is a mechanical problem.
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