Clinical Presentation and Diagnosis of TLS General

• Patients present primarily with lab abnormalities

• Normal uric acid is equal to 2 to 8 mg/dL (119-476 |imol/L)

• Most often occurs within 12 to 72 hours of initiation of cytotoxic therapy Signs and Symptoms

• Most patients are asymptomatic

• Patients may develop edema, fluid overload, and oliguria, which may progress to anuria with acute renal failure

• Some patients with hyperuricemia may have nausea, vomiting, and lethargy

• Hyperkalemia—lethargy, muscle weakness, paresthesia, ECG changes, bradycar-dia

• Hypocalcemia—muscle cramps, tetany, irritability, paresthesias, arrhythmias Laboratory Tests (Adults)

• Serum uric acid level greater than 8 mg/dL (476 |imol/L)

• Serum potassium greater than 6 mEq/L (6 mmol/L)

• Serum phosphorus greater than 4.5 mg/dL (1.45 mmol/L)

• Elevated BUN and creatinine once renal dysfunction develops OR

• A change of greater than 25% from baseline in the above lab values

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