Cellular breakdown during the tumor lysis syndrome results in the release of several electrolytes. Therapy may be needed if significant electrolyte abnormalities occur.


Common serum electrolyte abnormalities:

(1) hyperphosphatemia

(2) hypocalcemia (serum calcium <= 1.75 mmol/L, <= 6.0 mg/dL)

(3) hyperkalemia


The presence of renal dysfunction may impair the ability of the body to excrete the electrolyte loads.

Electrolyte Problem




moderate (serum phosphate >= 2.1 mmol/L)

avoid IV infusion of phosphate; administer phosphate binders



as for moderate; dialysis or hemofiltration



no treatment but monitor levels



calcium gluconate 50-100 mg per kg IV given slowly with ECG monitoring


moderate (>= 6.0 mmol/L) and asymptomatic

avoid oral or IV potassium; monitor ECG, consider sodium polystyrene sulphonate



as for moderate plus see note below


severe (> 7 mmol/L

as for moderate plus see note below



• Sodium polystyrene sulphonate is a cation exchange resin that is insoluble in water.


Treatment for symptomatic or severe hyperkalemia:

(1) consider dialysis

(2) calcium gluconate 100-200 mg/kg by slow IV infusion if the patient has life-threatening arrhythmias (monitor ECG during the infusion and do not infuse through the same line as the sodium bicarbonate)

(3) inject regular insulin 0.1 U/kg IV while infusing D25W 2 mL/kg

(4) sodium bicarbonate 1-2 mEq/kg IV push (do not infuse through the same line as the calcium gluconate)


Treatment of renal dysfunction:

(1) control and monitor fluid and electrolyte intake and excretion

(2) monitor and manage uric acid and phosphate levels

(3) adjust drug dosages for the creatinine clearance

(4) consider dialysis or hemofiltration


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