Tumor lysis syndrome
ICD-10 E88.3 · ICD-11 5D01

Treatment of Established Laboratory or Clinical Tumour Lysis Syndrome

This protocol covers the active treatment of patients — both adult and paediatric — in whom tumour lysis syndrome has already been confirmed, either as laboratory TLS (metabolic abnormalities meeting diagnostic criteria) or as clinical TLS (end-organ consequences already present).

Clinical Scenario The patient has established laboratory or clinical tumour lysis syndrome. This is a confirmed, active diagnosis requiring immediate intervention beyond prophylactic measures.
Primary Treatment Goal Maintain a urine output of 100 mL/m²/h in adults to support metabolic clearance and protect end-organ function.
Treatment Overview (partial)

Management begins with vigorous intravenous fluid replacement titrated to urine output, combined with a specific pharmacological strategy to address hyperuricaemia. Additional targeted interventions are required for the electrolyte disturbances associated with established TLS …

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References

  1. Adult and paediatric patients with established TLS (laboratory or clinical TLS) should be treated with rasburicase 0.2 mg/kg/day for up to 7 days (although 3–5 days is frequently sufficient) with the exact duration based upon clinical response (1B).
  2. Vigorous hydration with intravenous fluid is an essential component of TLS treatment.
  3. For adults, a rate of 3 L/m² should be initiated and the ongoing rate adjusted to maintain a urine output of 100 mL/m²/h.
  4. In children, a rate of up to 4 L/m² can be given, depending on renal function, clinical and fluid status.
  5. The aim is to maintain a urine output of 100 mL/m²/h in adults (1B).
DOI: 10.1111/bjh.70092
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