metabolic complications

Question 1

tumour lysis syndrome

Answer 1

breakdown of tumour cells + subsequent release of chemical from cancer cell

• potentially deadly condition related to the treatment of high-grade lymphomas + leukaemias

Question 2

usual trigger of tumour lysis syndrome

Answer 2

introduction of combination chemotherapy
- can occur in absense of chemo
- can occur with steroid treatment alone

Question 3

what electrolyte changes are seen in tumour lysis syndrome

Answer 3

high potassium
high phosphate
LOW calcium

Question 4

when should you suspect tumour lysis syndrome

Answer 4

leukaemia/lymphoma patient presenting with an AKI in presence of high phosphate + high uric acid level

Question 5

prevention of tumour lysis syndrome

Answer 5

IV fluids
if high risk = rasburicase
lower risk = allopurinol
(**should not be given together)

Question 6

scoring system for tumour lysis syndrome

Answer 6

Cairo-Bishop scoring system

Question 7

tumour lysis presentation

Answer 7

Nausea and vomiting
Fatigue
Dark urine
Reduced urine output
Flank pain
Numbness, seizures, or hallucinations
Muscle cramps and spasms
Heart palpitations

(in someone with leukaemia/lymphoma)

Question 8

hypercalcaemia presentation

Answer 8

‘bones, stones, groans and psychic moans’
- (constipation, confusion, puluria/dipsia)
corneal calcification
shortened QT interval on ECG
hypertension

Question 9

why does hypercalcaemia occur in malignancy

Answer 9

from tumour secretion of parathyroid hormone-related protein (PTHrP), leading to increased bone resorption and renal tubular calcium reabsorption

• may also arise due to local osteolytic activity or ectopic production of calcitriol in some lymphomas

Question 10

management of hypercalcaemia

Answer 10

bisphosphonates / denosumab