Last reviewed: 4 Oct 2024
Last updated: 03 May 2024
Summary
Definition
History and exam
Key diagnostic factors
- hematologic malignancy
- recent cancer treatment (particularly chemotherapy)
- pre-existing renal impairment
- cardiac arrhythmia (including syncope, chest pain, dyspnea)
- seizures
Full details
Other diagnostic factors
- nausea and vomiting
- anorexia
- diarrhea
- muscle weakness
- muscle cramps
- lethargy
- paresthesia
- lymphadenopathy
- splenomegaly
- hypertension/hypotension
- oliguria/anuria/hematuria
- cloudy urine
- joint pain/discomfort
- solid tumor malignancy
- tetany
- Trousseau sign
- Chvostek sign
- laryngeal spasm
- peripheral edema
- confusion/delirium/hallucinations
- flank pain
Full details
Risk factors
- hematologic malignancy
- large tumor burden
- treatment-sensitive tumors
- recent cancer treatment (particularly chemotherapy)
- pre-existing renal impairment
- dehydration
- volume depletion
- use of nephrotoxic agents
- advanced age
Full details
Diagnostic tests
1st tests to order
- serum uric acid
- serum phosphate
- serum potassium
- serum calcium
- CBC
- serum lactate dehydrogenase (LDH)
- serum creatinine
- serum blood urea nitrogen (BUN)
- urine pH
Full details
Tests to consider
- ECG
Full details
Treatment algorithm
INITIAL
low risk
intermediate risk
high risk
ACUTE
laboratory or clinical TLS
Contributors
Authors
Tariq Mughal, MD, FRCP, FACP, FRCPath
Clinical Professor of Medicine
Tufts University Cancer Center
Boston
MA
Disclosures
TM declares that he has no competing interests. TM is an author of an article cited in the topic.
Acknowledgements
Professor Tariq Mughal would like to gratefully acknowledge Dr James Larkin and Dr Anastasia Constantinidou, previous contributors to this topic.
Disclosures
JL and AC declare that they have no competing interests.
Peer reviewers
Shereen Ezzat, MD
Professor of Medicine and Oncology
University of Toronto
Toronto
Ontario
Canada
Disclosures
SE declares that he has no competing interests.
David Landau, MB BS, MRCP, FRCR
Consultant Clinical Oncologist
Guy's & St. Thomas' NHS Trust
Honorary Senior Lecturer
Imaging Sciences Division
King's College Hospital
London
UK
Disclosures
DL declares that he has no competing interests.
Differentials
- Isolated hyperuricemia
- Isolated hyperkalemia
- Isolated hyperphosphatemia
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: T-cell lymphomas
- NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma
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