How to manage electrolyte abnormalities in Tumor lysis syndrome?
Hyperkalemia is a frequent laboratory abnormality in TLS as a consequence of potassium release from lysed tumor cells. If the amount of tumor lysis is massive, hyperkalemia can be life-threatening.
Associated oliguria or anuria can worsen the clearance of potassium as urine flow drops off. Hyperkalemia in TLS is managed no differently than hyperkalemia from other causes.
In the absence of symptoms, it is not necessary to treat hypocalcemia in TLS. Worrisome clinical signs of symptomatic hypocalcemia include paresthesias, cramping, tetany, seizures, and a prolonged QT interval on electrocardiography. Symptomatic hypocalcemia is rare in TLS. Electrocardiographic changes such as a prolonged PR interval, widened QRS complex, or peaked T waves in the setting of hyperkalemia would also be an additional indication for calcium therapy. Hyperphosphatemia in TLS may be difficult to manage, as phosphate binders only decrease phosphorus absorption but do not decrease hyperphosphatemia from intracellular release.
