H. L is a 65-year-old Caucasian male diagnosed with Hodgkin’s Lymphoma (NHL) 4 months ago. He just finished receiving his third of six chemotherapy courses 5 days ago. Yesterday morning, he was seen at his oncologist’s office for malaise, muscle weakness, and palpitations. He had splenomegaly on examination. A computerized tomography (CT) scan of the abdomen showed metastatic disease in the liver and spleen. He is admitted to the hospital with progressive disease. The physician confirms a diagnosis of acute tumor lysis syndrome (TLS) and writes a number of orders for H. J. Required:
What major complication of TLS is H. J. at risk for and why?

The correct answer would be - renal failure, kidney stones, uric acid neuropathy and other complications.

Explanation:

The symptoms of H.J include decreased urine output, flank pain, peripheral edema. H.J. is at risk for acute kidney injury which can result in renal failure due to elevated levels of uric acid, BUN, and creatinine.

Uric acid begins to precipitate in the kidneys and leads to conditions such as uric acid nephropathy and subsequent kidney injury. ECG shows in such patients as elevated heart rate due to hyperkalemia and hypocalcemia.

- Muscle cramps, Diarrhea, Nausea, and vomiting

- Renal failure due to kidney stones because of high uric acid.

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