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Clinical reference
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EmergencyAwaiting clinical review

Tumour lysis syndrome

Highest risk in bulky ALL, Burkitt and high-WCC presentations during the first 72 h of therapy.

Hyperkalaemia
K⁺ >6.0 mmol/L — act immediately
Monitoring
Labs 6–8 hourly while high risk
Hydration
2–3 L/m²/day, no added potassium

Risk stratification

  • High: Burkitt lymphoma, T-cell ALL with WCC >100 ×10⁹/L, bulky disease with renal involvement.
  • Intermediate: ALL with WCC 50–100, advanced-stage lymphoblastic lymphoma.
  • Low: most solid tumours, low-count ALL — standard hydration and daily labs.

Prophylaxis and management

  • Hyperhydration without potassium; maintain high urine output and check fluid balance hourly in high risk.
  • Allopurinol for low/intermediate risk; rasburicase for high risk or established hyperuricaemia.
  • Screen G6PD before rasburicase — haemolysis risk. Transport uric acid samples on ice.
  • Do not give routine alkalinisation; it worsens calcium-phosphate precipitation.
  • Treat hypocalcaemia only when symptomatic.

Escalate

  • K⁺ >6.0 mmol/L, ECG changes, oliguria despite fluids, or rapidly rising creatinine — call nephrology and PICU for renal replacement planning.

Sources and local override

  • Local TLS prophylaxis protocol — Risk tiers and rasburicase criteria vary by centre.

Next review due 2027-02-01.