Case of the Month #15 - rasburicase

Published 02/02/2022

What initial management would be appropriate?

This is a haematological emergency. She has dangerously deranged electrolytes and is symptomatic, therefore has severe tumour lysis syndrome. She will need admission to critical care for continuous monitoring of heart rate and rhythm, a 12-lead ECG, SpO2, blood pressure, insertion of an arterial line and central venous line as regular blood sampling will be needed, and she is at risk of haemodynamic instability. She requires IV fluid resuscitation, urinary catheterisation, replacement of calcium, and medical treatment of hyperkalaemia including salbutamol nebulisers, insulin-dextrose and cardioprotection with 10% calcium gluconate. She should not receive any nephrotoxic drugs. If she remains hyperkalaemic, or ongoing/worsening AKI then renal replacement therapy is indicated. She will need to be treated with rasburicase, and close liaison with haematology.