Tumour lysis syndrome — ESENeph MCQ

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HardAcute Kidney Injury, Electrolytes and Acid-BaseTumour lysis syndromeESENeph

A 49-year-old woman with acute myeloid leukaemia develops oliguria 18 hours after induction chemotherapy. Potassium is 6.3 mmol/L, phosphate 2.4 mmol/L, corrected calcium 1.82 mmol/L, urate 0.78 mmol/L and creatinine 244 micromol/L. ECG shows tall T waves despite initial medical treatment. What is the most appropriate management?

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Correct answer: D — Temporise hyperkalaemia and start urgent RRT

This is tumour lysis syndrome with severe hyperkalaemia and AKI; ECG changes and inadequate response to temporising treatment make urgent renal replacement therapy appropriate. Phosphate replacement would worsen hyperphosphataemia and hypocalcaemia. Allopurinol prevents urate generation but does not rapidly remove existing electrolyte threats. The pearl is that dialysis decisions in tumour lysis are driven by life-threatening potassium, phosphate, acidosis, fluid overload and uraemic complications. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: BCSH tumour lysis guidance; NICE NG148: https://www.nice.org.uk/guidance/ng148/chapter/recommendations