Tumor lysis syndrome

Last reviewed: 1 Nov 2022
Last updated: 26 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • hematologic malignancy
  • pre-existing renal impairment
  • syncope/chest pain/dyspnea
  • seizures
More key diagnostic factors

Other diagnostic factors

  • nausea and vomiting
  • anorexia
  • diarrhea
  • muscle weakness
  • muscle cramps
  • lethargy
  • paresthesia
  • lymphadenopathy
  • splenomegaly
  • hypertension/hypotension
  • oliguria/anuria/hematuria
  • solid tumor malignancy
  • tetany
  • Trousseau sign
  • Chvostek sign
  • laryngeal spasm
  • peripheral edema
Other diagnostic factors

Risk factors

  • hematologic malignancy
  • large tumor burden
  • chemosensitive tumors
  • recent chemotherapy
  • pre-existing renal impairment
  • dehydration
  • volume depletion
  • nephrotoxic medication
  • advanced age
More risk factors

Diagnostic investigations

1st investigations to order

  • serum uric acid
  • serum phosphate
  • serum potassium
  • serum calcium
  • CBC
  • LDH
  • serum creatinine
  • serum BUN
  • urine pH
More 1st investigations to order

Investigations to consider

  • ECG
More investigations to consider

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 has consulted for Roche Foundation Medicine, Sangamo Therapeutics, Stemline Therapeutics, Novartis, and Sanofi.

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: B-cell lymphomas
    • Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies
    More Guidelines
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