Lysing Luis — Tumor Lysis Syndrome
K⁺ ↑, uric acid ↑, phosphate ↑, Ca²⁺ ↓ — cells burst 24–72 hrs post-chemo
Luis feels fine right after his infusion, proud he tolerated it so well. Thirty-six hours later he is cramping, his urine has slowed, and the monitor shows peaked T waves.
Luis has a bulky lymphoma and just received his first dose of chemotherapy. As tumor cells die rapidly, they dump their contents — potassium, phosphate, and uric acid — straight into the bloodstream, and calcium drops as it binds to the excess phosphate. This electrolyte storm can shut down the kidneys and stop the heart. Aggressive IV hydration and allopurinol or rasburicase before treatment are the prevention plan.
Read Lysing Luis's full story →The story arc
The setup
Luis has a large, fast-growing lymphoma — exactly the kind of tumor that lyses rapidly once chemotherapy starts.
The turn
He feels well the day of treatment, so no one is alarmed — but his labs already show uric acid climbing.
The crisis
He develops muscle cramps and tingling around his mouth, his urine output drops, and the monitor shows peaked T waves. Potassium is 6.4, phosphate is 8.9, calcium is 6.8.
The save
Aggressive IV fluids flush the kidneys, rasburicase breaks down uric acid, potassium is treated per protocol, and cardiac monitoring continues until labs normalize.
NCLEX study section — Tumor Lysis Syndrome
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Critical Care
Take this chapter into practice questions on the same topic.