see also oncology

• haematological malignancies (acute leukaemias & lymphomas)

• occurs within 1- 5 days of chemo/XRT of rapidly growing tumours that are extremely sensitive to treatment
• in general, patients with solid tumours are not at risk
• risk increased with:
  • large bulk of the tumour
  • hyperuricaemia - prior to Rx
  • renal impairment - prior to Rx

• ARF (kidney provides 1° mech. for K+/uric acid/phosphate)
• Integrity of renal Fx is critical in determining degree of metabolic derangements
• cardiac dysrhythmias / sudden death ( hypocalcaemia, hyperkalaemia)
• neuromuscular symptoms
• hyperuricaemia (DNA breakdown)
• hyperkalaemia (cytosol breakdown)
• hyperphosphatemia (protein breakdown)
• hypocalcaemia (2° to hyperphosphatemia)

• serum uric acid
• U&E
• serum calcium, phosphate
• delay chemo/XRT until metabolic derangements are corrected
• haemodialysis if: 
  • raised K+ ( ? if >6)
  • raised Uric acid ( ? if >59)
  • raised Cr ( ? if >0.9)
  • raised Phosphate ( ? if > 3.2)
  • volume overload
  • symptomatic hypocalcaemia

• good in absence of renal failure
• if renal failure + hemodialysis is required > 5 days, prognosis is grave