Evaluation and Treatment of Oncology Patients at Risk for Tumor Lysis Syndrome (TLS) — Clinical Signs and Symptoms — Clinical Pathway: Inpatient, ICU, Outpatient Specialty Care, ED

Tumor Lysis Syndrome Clinical Pathway — Inpatient, ICU

Clinical Signs and Symptoms Associated with TLS

The table below includes clinical signs with associated symptoms of TLS.

Risk assessment for TLS also includes evaluation of labs.

Definition of abnormal labs for this pathway:

  • Greater than upper limit of normal (> ULN) K/PO4/uric acid or
  • Less than the lower limit of normal (< LLN) Ca

Lab parameters should be based on patient age and institution-specific lab parameters. Please refer to your institution’s lab parameters. Review patient vital signs, clinical exam, and lab studies with fellow/attending when assigning risk.

Labs Signs/Symptoms
Hyperuricemia
  • Decreased urine output
  • Kidney/bladder stones
Hyperphosphatemia  
Hyperkalemia
  • Cardiac dysrhythmia
  • ECG changes
    • Peaked T waves
    • Widened and flattened P waves
    • PR prolongation
    • QRS prolongation
    • Abnormal QRS morphology
  • Conduction block (atrial or ventricular)
Hypocalcemia
  • Cardiac dysrhythmia
  • ECG changes
    • QTc prolongation
  • Seizure
  • Neuromuscular irritability, sensory disturbance
  • Tetany, paresthesia of hands and feet, circumoral numbness, generalized muscle cramps, muscle twitching, carpopedal spasm, Trousseau’s sign, Chvostek’s sign, laryngospasm, or bronchospasm
  • Hypotension
  • Heart failure
  • Note:
    True hypocalcemia implies a drop in Ionized calcium or alkalosis wherein the proportion of serum calcium in ionized form is decreased
Acute Kidney Injury Oliguria, defined as an average urine output of < 0.5 mg/kg/hr x 6 hrs

Reference

The Tumor Lysis Syndrome