Quiz — Acute lymphoblastic leukemia (ALL)

A 12-year-old girl is 36 hours into induction for T-cell ALL with a presenting WBC of 210,000/µL. Labs: potassium 6.2 mEq/L, phosphorus 8.4 mg/dL, calcium 6.9 mg/dL, uric acid 13 mg/dL, creatinine 1.6 mg/dL (baseline 0.5). Which management step is most appropriate?

• AAdd potassium to maintenance fluids and continue allopurinol
• BGive rasburicase and continue aggressive IV hydration without potassium
• CStart bicarbonate-based urine alkalinization to raise urine pH above 7.5
• DTransfuse calcium gluconate to correct the hypocalcemia to normal range