Tumor Lysis Syndrome Clinical Presentation

Updated: Oct 04, 2022
  • Author: Alan K Ikeda, MD; Chief Editor: Wafik S El-Deiry, MD, PhD  more...
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In tumor lysis syndrome, a constellation of clinical signs and symptoms may develop prior to the initiation of chemotherapy or, more commonly, within 72 hours after administration of cytotoxic therapy. [22] Inquiries should be made with regard to the following:

  • Time of onset of symptoms of malignancy
  • Presence of abdominal pain and distension
  • Presence of urinary symptoms - Such as dysuria, oliguria, flank pain, and hematuria
  • Occurrence of any symptoms of hypocalcemia - Such as anorexia, vomiting, cramps, seizures, spasms, altered mental status, and tetany
  • Symptoms of hyperkalemia - Such as weakness and paralysis

Other manifestations of tumor lysis syndrome include the following:

  • Lethargy
  • Edema
  • Fluid overload
  • Congestive heart failure
  • Cardiac dysrhythmias
  • Syncope
  • Sudden death

Physical Examination

Symptoms reflect the severity of underlying metabolic abnormalities. Hyperkalemia can cause paresthesia, weakness, and fatal cardiac arrhythmias.

Severe hypocalcemia can lead to the following signs and symptoms:

  • Paresthesia and tetany with positive Chvostek and Trousseau signs
  • Anxiety
  • Carpal and pedal spasms
  • Bronchospasm
  • Seizures
  • Cardiac arrest

Deposition of calcium phosphate in various tissues may be responsible for the following signs and symptoms:

  • Pruritus
  • Gangrenous changes of the skin
  • Iritis
  • Arthritis

Uremia can produce the following signs and symptoms:

  • Fatigue
  • Weakness
  • Malaise
  • Nausea
  • Vomiting
  • Anorexia
  • Metallic taste
  • Hiccups
  • Neuromuscular irritability
  • Difficulty concentrating
  • Pruritus
  • Restless legs
  • Ecchymoses

As uremia progresses, paresthesia and evidence of pericarditis may develop, as well as signs of drug toxicity from medications eliminated by the kidney. Features of volume overload, such as dyspnea, pulmonary rales, edema, and hypertension, may develop.

Elevated uric acid levels may produce lethargy, nausea, and vomiting. Rapidly increasing uric acid levels may lead to arthralgia and renal colic.