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Tumor lysis syndrome — ABIM Board MCQ

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HardHematology/OncologyTumor lysis syndromeABIM Board

A 58-year-old with bulky lymphoma develops potassium 6.1 mEq/L, phosphate 7.2 mg/dL, calcium 7.0 mg/dL, uric acid 14 mg/dL and rising creatinine 12 hours after chemotherapy. ECG shows peaked T waves. Which initial plan is preferred?

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Correct answer: D — Give IV calcium, shift potassium, hydrate and administer rasburicase

The best answer is “Give IV calcium, shift potassium, hydrate and administer rasburicase”. This is established tumor lysis syndrome with ECG-toxic hyperkalemia. Immediate calcium and potassium shifting address the lethal electrical risk, while vigorous hydration and rasburicase rapidly lower uric acid. Allopurinol prevents new uric acid formation but is slower and does not remove existing urate; asymptomatic hypocalcemia is otherwise not routinely corrected.

Reference: ASCO Review: Tumor Lysis Syndrome: https://ascopubs.org/doi/10.1200/JCO.2008.17.1466