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Tumor lysis syndrome

Last reviewed: 30 Sep 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 Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: T-cell lymphomas
    • NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma
    More Guidelines
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