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Tumour Lysis Syndrome, Rapid Tumour Lysis, secondary Hypocalcemia, causes,…

- - - - Urate and calcium crystal nephropathy
        Tubular obstruction
        
        worsens electrolytes clearance
  - - - Tetany, Seizures and prolonged QT
  - - - ↑ pottasium → Hyperkalaemia →arrythmias
      - ↑ phosphate → hyperphosphataemia →binds with calcium
      - nucleic acid breakdown → uric acid ↑ →tubular crystal deposition → AKI
  - - - Multi-organ failure
      - Seizures or neuromuscular irritability
      - Cardiac Arrythmias
- - - - Clinical TLS
        → Laboratory TLS +
        • Creatinine ≥1.5 × ULN (upper normal limit) or
        • cardiac arrhythmia/sudden death or
        • seizure.
      - Laboratory TLS: ≥2 abnormalities
        → Uric acid ≥476 μmol/L or ≥25% ↑
        → K⁺ ≥6.0 mmol/L or ≥25% ↑
        → PO₄³⁻ ≥1.45 mmol/L or ≥25% ↑
        → Ca²⁺ ≤1.75 mmol/L or ≥25% ↓
  - - - age, cancer type, tumor burden, treatment type, renal function and morbidity
    - - Low risk: Most solid tumours; low tumour burden
        
        Outpatient monitoring - every 12 hours
      - Intermediate risk: SCLC + bulky/advanced disease; ↑ LDH
        
        Out-patient monitoring - every 12 hours or BD
      - High risk: Bulky/high-burden disease + renal dysfunction or baseline ↑ urate/K⁺/phosphate
        
        should receive IP treatment
        
        every 6 hours or with CTLS & LTLS - 4-6 hourly
    - - Monitor Electrolyte changes from baseline
      - Monitor ECG for changes / arrythmias
      - ↓ urine output + ↑ creatinine → AKI
      - Fluid overload or pulmonary edema