A 44 year old female patient is admitted to the oncology ward to undergo chemotherapy for Diffuse Large B-Cell lymphoma stage IVb. She had originlly presented to her GP with intermittent abdominal bloating and constipation and occasional shortness of breath. She also reported having to often get up in the middle of the night to change the bed clothes due to drenching sweats. Her GP had been concerned by these symptoms and had organised an immediate chest X-ray to be undertaken at the nearby hospital.
Chest X-ray
large mediastinal mass with clear lung fields.
On receiving this report the GP arranged an urgent appointment with a local haematologist as he suspected that the patient was suffering from lymphoma. She was seen only 4 days later. Given the clinical history the team at the hospital arranged some urgent investigations.
Hb 9.5 g/dl
Platelets 140 * 109/l
WBC 36.5 * 109/l
Lactate Dehydrogenase 2540IU/l
CT-guided Lymph node biopsy
cells are large, with prominent nucleoli and abundant cytoplasm and many mitoses expressing CD19 and CD20 markers
PET scan
large extra-nodal disease bulks most notable in the ileo-caecal area and in the mediastinum. Overall bulky disease in keeping with the diagnosis of advanced stage lymphoma.
The patient is admitted to receive cycle one of R-CHOP chemotherapy under close monitoring.
What electrolyte abnormalities would suggest tumour lysis syndrome?
High Potassium, high Calcium, low Phosphate
Low Potassium, high Calcium, low Phosphate
High Potassium, low Calcium, high Phosphate
Low Potassium, low Calcium, high Phosphate
Low Potassium, low Calcium, low Phosphate