Tumor lysis syndrome Management Multidisciplinary management Manage patients with established TLS in a multidisciplinary setting including a team of hematologists, nephrologists and intensive care physicians. B Transfer patients to an intensive care/high-dependency unit, if local facilities are not available for intensive management and monitoring. B Intravenous fluids Administer balanced or isotonic crystalloid solutions to maintain urine output > 100 mL/m /hour (target > 4 mL/kg/hour for infants). B Avoid adding potassium to the hydration fluid. D Urine alkalinization Avoid using urine alkalinization for the treatment of TLS. D Cardiac monitoring Q Is serum potassium level 6 mmol/L? Q Is serum potassium increased 25% from baseline? Yes to any Provide cardiac monitoring for patients with potassium levels 6 mmol/L or a 25% increase from baseline. B No to all Management of hypocalcemia Q Does the patient have symptomatic hypocalcemia? Yes Administer a short infusion of calcium gluconate in patients with symptomatic hypocalcemia, with close monitoring of calcium levels, phosphate levels, and renal function. B Avoid treating asymptomatic hypocalcemia in patients with TLS. D No Rasburicase Q Does the patient have G6PD deficiency? Q Does the patient have an allergy to rasburicase? Yes to any Avoid using allopurinol as a treatment for established TLS, with the exception of patients with contraindications to rasburicase. D No to all Administer rasburicase (0.2 mg/kg IV once daily) to patients with established TLS, in the absence of contraindications. B Determine the duration of treatment according to clinical response. B Dialysis Q Does the patient have intractable fluid overload? Q Does the patient have intractable hyperkalemia, hyperphosphatemia, or hypophosphatemia? Q Does the patient have intractable hyperuricemia? Yes to any Initiate RRT in patients with intractable fluid overload, hyperkalemia, hyperuricemia, hyperphosphatemia, or hypocalcemia. A Avoid peritoneal dialysis for the management of TLS. D Continue RRT until there is adequate recovery of renal function, resolution of severe electrolyte imbalance, and recovery of urine output. A No to all Continue management and follow-up as clinically appropriate.