The Acute Tumor Lysis Syndrome (TLS) occurs when a rapid necrosis of a lymphoid neoplasm results in release of cellular components, especially nucleic acids. This can have a number of metabolic consequences including acute renal failure and death.


Lymphoid neoplasms associated with acute tumor lysis:

(1) Burkitt's lymphoma (most common)

(2) acute lymphocytic leukemia

(3) prolymphocytic leukemia

(4) other lymphomas



(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



(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



(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.


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