This handout is for tumor lysis syndrome (tls). Your care team identified this based on: lab tls: >=2 of uric acid >=8, k >=6, po4 >=4.5, ca <=7 (or 25% change from baseline) within 3 days before or 7 days after cytotoxic therapy — cairo-bishop jco 2004.
Other reasons your team may use this plan: clinical tls: lab tls + renal failure (cr >=1.5x uln), cardiac arrhythmia, seizure, or sudden death — cairo-bishop jco 2004; high-risk malignancy (burkitt, all with wbc >100k, dlbcl with bulky disease) before initiating cytotoxic therapy — coiffier jco 2008; nccn 2024.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| IV_hydration | NS or LR at 150-200 mL/h (2-2.5 L/m2/day) | IV | continuous | Coiffier JCO 2008 — maintain UOP >=2 mL/kg/h; dilute uric acid and phosphate |
Plan: TLS prevention: allopurinol + IVF (intermediate risk) vs rasburicase + IVF (high risk) — Coiffier JCO 2008; NCCN 2024
Call 911 or go to the nearest emergency room right away if you have:
Transition to daily labs once stable; resume chemotherapy when TLS resolved + electrolytes normalized + renal function recovered; document TLS episode for future cycle risk assessment; dose-adjust or change chemo regimen if recurrent TLS — Coiffier JCO 2008; NCCN 2024
Guideline: Cairo-Bishop TLS classification (Br J Haematol 2004); Coiffier et al TLS expert consensus (JCO 2008); Howard/Jones/Pui TLS review (NEJM 2011); NCCN Management of Tumor Lysis Syndrome