Tumor Lysis Syndrome - Case Study - Burkitt Lymphoma the Night Before Chemotherapy

Every number is still normal, the patient looks well, and chemotherapy starts in the morning - this is the night tumor lysis syndrome is either prevented or set loose. A case-based walkthrough in which a senior resident presents a 32-year-old auto body painter with bulky Burkitt-type high-grade B-cell lymphoma and reasons out loud through the risk, the mechanism, and the orders to write before the first dose. What you'll learn: • How to read risk from a presentation where the creatinine, potassium, phosphate and calcium are all normal but the LDH is ten times the upper limit and the uric acid sits at the ceiling • Why massive simultaneous cell death is a rate problem rather than a capacity problem - the same load released slowly would cause nothing at all • The electrolyte quartet with the causal arrow spelled out: potassium straight out of a cell holding 140 against 4 milliequivalents per liter, urate from nucleic acid catabolism, phosphate from a loaded lymphoblast, and calcium falling because the phosphate rose • Urate nephropathy in the distal tubule and collecting duct, with calcium phosphate precipitating in the same lumens, and the vicious circle that accelerates on its own • The ward plan: allopurinol and aggressive hydration started before chemotherapy, ibuprofen and IV contrast stopped, rasburicase 0.1 to 0.2 mg per kilogram or a 6 mg IV fixed dose, and G6PD testing first because a deficient red cell cannot neutralize the hydrogen peroxide rasburicase generates Key takeaway: Prophylaxis goes in before the first dose, calcium follows phosphate so fix the cause, and call renal before the urine stops. ⏱ Chapters: 0:00 The admission: bulky lymphoma with every chemistry still normal 2:39 Pathophysiology: a rate problem and the electrolyte quartet 4:52 Purine catabolism, urate nephropathy, and the vicious circle 7:05 Assessment and plan: prophylaxis, what to avoid, rasburicase and G6PD 10:55 Dispo and teaching pearls Part of Teaching Service — Hospital Rounds: education for residents and advanced practice providers. For clinician and trainee education only. Not medical advice; verify against current guidelines and institutional protocols before applying to patient care. #TumorLysisSyndrome #BurkittLymphoma #OncologicEmergency #CaseStudy #Rasburicase #Allopurinol #Hyperphosphatemia #G6PDDeficiency #InternalMedicine #MedicalEducation