Patients with TLS are diagnosed based on laboratory monitoring indicating hyperuri-
cemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and renal dysfunction. As a result of these electrolyte abnormalities, patients may present with uremia, visual disturbances, muscle cramping, edema, hypertension, cardiac arrhythmias, seizures,
and even sudden death.
Table 99-14 Risk Factors for TLS
Disease Related High risk
Acute lymphoblastic leukemia
High-grade non-Hodgkin's lymphoma (i.e., Burkitt's) Intermediate risk
Chronic lymphocytic leukemia (especially bulky lymphadenopathy) Acute myeloid leukemia (especially WBC greater than 50,000/mm ) Multiple myeloma Low risk
Low- and intermediate-grade non-Hodgkin's lymphoma Hodgkin's disease
Chronic myeloid leukemia (blast crisis)
Small cell lung cancer Testicular cancer Patient related
Decreased urinary output, dehydration, or renal failure Pre-existing hyperuricemia Acidic urine
Lactate dehydrogenase (LDH) levels greater than 1500 IU/L (1500 units/L) High tumor sensitivity to treatment modalities
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