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Tumour lysis syndrome — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesTumour lysis syndromeSCE Acute Medicine

A 55-year-old man is assessed on the acute medical unit. He has newly treated Burkitt lymphoma with potassium 6.4 mmol/L, phosphate 2.4 mmol/L, urate 820 micromol/L and AKI. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Give aggressive intravenous hydration and rasburicase discussion

Give aggressive intravenous hydration and rasburicase discussion is the best answer because established TLS with AKI and hyperuricaemia needs vigorous management and rasburicase consideration. Give broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Hypocalcaemia should not be corrected unless symptomatic because calcium-phosphate precipitation may worsen.

Reference: BCSH tumour lysis guideline