43 M with Lung Ca

• CC weakness, fluid retention (including ascites)

LABS

• Ca 1.4
• K 6.8
• LDH 1900
• Creat 248
• THOUGHTS?

Tumour Lysis Syndrome

• Oncological Emergency
• Severe metabolic derangement secondary to high cell mass malignancies
• Most common in leukemias and lymphomas, though also found in HCC, testicular CA, SCLCA, breast, neuroblastoma

Symptoms

• weakness
• paresthesias
• palpitations
• stiffness/tetany
• edema
• GI upset

Labs

• hyperkalemia
• hyperphosphatemia
• hypocalcemia
• hyperuricemia
• renal impairment
• high LDH
• lactic acidosis

Treatment

• Hydration/+/- diuretics
• Allopurinol (up to 800 mg per day)
• Rasburicase (oxidizes uric acid)
• Treat hyperK as priority
• Dialysis if appropriate

Who is tired of the word COVID?

Consider an elective in Palliative Care