Lymphoid neoplasms associated with acute tumor lysis:
(1) Burkitt's lymphoma (most common)
(2) acute lymphocytic leukemia
(3) prolymphocytic leukemia
(4) other lymphomas
Settings:
(1) rapid tumor growth with spontaneous tumor necrosis/lysis
(2) chemotherapy without concurrent allopurinol
(3) chemotherapy with concurrent allopurinol in the setting of hypoxanthine-guanine phosphoribosyltransferase deficiency
Findings:
(1) hyperuricemia (often > 1.5 times the upper limit of normal reference range)
(2) hyperphosphatemia (following chemotherapy; may be absent with spontaneous tumor lysis)
(3) hypocalcemia (from calcium-phosphate precipitation and other mechanisms)
(4) hyperkalemia
(5) acidosis
(6) marked increase in serum LDH
(7) acute renal failure with oliguria due to uric acid or xanthine nephropathy
(8) sudden cardiac arrhythmias
Prevention:
(1) treatment with allopurinol
(2) good hydration with diuresis
(3) urine alkalinization with intravenous bicarbonate and carbonic anhydrase inhibitors
Once renal failure develops, sodium bicarbonate should be used cautiously to prevent volume overload and metabolic alkalosis. Dialysis is usually necessary to remove the uric acid and maintain the patient until recovery of renal function can occur.
