Tumour Lysis Syndrome

This case is written by Dr. Donika Orlich; 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.

Clinical Vignette

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.

Case Summary

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:

ecg90406-hyperkalaemia-pr-lengthens

(Source:  http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/)

normal-sinus-rhythm

(Source:  http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/12/normal-sinus-rhythm.jpg)

CXR for the case found here:

CXR

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