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Rapid malignant-cell breakdown releases potassium, phosphate and nucleic acids, provoking dysrhythmia, hypocalcaemia and urate-associated acute kidney injury.
Consider a patient with high-grade haematological cancer, recent therapy or rapidly proliferating disease who develops nausea, weakness, tetany, oliguria or arrhythmia.
Urgently contact haematology/oncology and renal/critical care teams. Initiate the trust tumour-lysis pathway and address life-threatening hyperkalaemia or organ dysfunction without delay.
Obtain serial potassium, phosphate, calcium, urate, creatinine and ECG monitoring, plus strict fluid balance. Specialist teams decide hydration, urate-lowering treatment and renal replacement needs.
Rasburicase access delays have triggered an NHS England national safety alert; the drug requires clinical suitability checks including G6PD-related considerations. Do not rely on allopurinol alone for established severe TLS.
UK reference: NHS England 2025 TLS safety alert. Focused editorial source check, 7 November 2026; this is not independent clinical or pharmacy sign-off. Verify current local policy, BNF/BNFC and specialist advice before treatment. Not a prescribing protocol.
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