Tumour Lysis Syndrome

Tumour lysis syndrome (TLS) is an oncological emergency. It is chemotherapy-induced or spontaneous cancer cell death, followed by release of intracellular contents into the bloodstream leading to haematological, metabolic and electrolyte derangements. It is often associated with hyperkalaemia, hyperphosphataemia and hypocalcaemia. Cell breakdown also leads to hyperuricaemia and uraemia. Classically a complication of haematological malignancies, with advent of newer chemotherapeutic agents solid tumour TLS, is also observed. TLS management comprises a multidisciplinary approach involving an oncologist, nephrologist, intensivist and intensive care unit (ICU) nursing staff. Life-threatening arrhythmias, acute renal failure, altered sensorium, seizures and multi-system organ failure are indications for ICU admission. Reno-protective fluid therapy is the mainstay of treatment. Managing hyperuricaemia, hyperphosphataemia and hypocalcaemia are other challenges. Allopurinol is drug of choice for hyperuricaemia. Rasburicase (a recombinant urate oxidase) and febuxostat have also been used. Haemodialysis may be employed for refractory hyperkalaemia, hyperphosphataemia or hyperuricaemia.