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Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency characterized by massive tumor cell breakdown, leading to release of intracellular contents into the bloodstream. It most commonly occurs following chemotherapy initiation in patients with rapidly proliferating, chemosensitive malignancies such as acute leukemias and high-grade lymphomas.
Rapid tumor cell death releases large quantities of intracellular potassium, phosphate, and nucleic acids into circulation, overwhelming normal excretory mechanisms. The breakdown of nucleic acids produces uric acid, leading to hyperuricemia, while massive cellular phosphate release causes hyperphosphatemia and secondary hypocalcemia due to calcium-phosphate precipitation.
Early recognition involves monitoring electrolyte abnormalities (hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia) and watching for clinical manifestations including cardiac arrhythmias, seizures, and acute kidney injury. Prevention with aggressive hydration, allopurinol or rasburicase, and careful monitoring is crucial in high-risk patients, while treatment focuses on correcting electrolyte imbalances and supporting organ function.