This case is written by Dr. Donika Orlich. She is a PGY5 Emergency Medicine resident at McMaster University who completed a fellowship in Simulation and Medical Education last year.
Why it Matters
Tumor Lysis Syndrome is a constellation of metabolic disturbances that can occur as a potentially fatal complication of treating cancers, most notably leukemias or solid rapidly-proliferating tumours. This case highlights the following:
- The identification and management of severe hyperkalemia
- The need to consider Tumour Lysis Syndrome as a diagnosis and order appropriate metabolic tests
- Recognizing and initiating the treatment of severe hyperuricemia
- Communicating with family members effectively during the treatment of a critically ill patient.
A 72-year-old male presents to the emergency department complaining of general weakness for 2 days. His wife called EMS and he was a STEMI patch to your hospital. He has been placed in the resuscitation bay.
A 72-year-old male is brought in as a “code STEMI” to the resuscitation bay. He was recently diagnosed with ALL and had chemotherapy 3 days ago for the first time. The patient is severely hyperkalemic, which must be initially recognized and treated, hypocalcemic and hyperuricemic as a result of Tumour Lysis Syndrome and the metabolic derangements must be stabilized until emergent hemodialysis is arranged.
Download the case here: Tumour Lysis Syndrome
ECGs for the case found here:
CXR for the case found here: