A patient recently initiated on systemic chemotherapy for a hematologic malignancy presents with nausea, abdominal cramping and oliguria. Laboratory workup reveals hyperuricemia, hyperkalemia, elevated serum creatinine and decreased urine concentrating ability. Which oncologic emergency is the patient most likely experiencing?

1. A

   Tumor Lysis Syndrome

2. B

   Syndrome of Inappropriate Antidiuretic Hormone

3. C

   Diabetes Insipidus, deficient ADH

4. D

   Dehydration

Appeared in: NORCET-11 Prelims

Explanation

• Tumor lysis syndrome is triggered by rapid cell breakdown after chemotherapy, especially in hematologic malignancies.
• It causes release of uric acid, potassium, and phosphate, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
• Acute kidney injury results from uric acid and calcium phosphate crystal deposition in renal tubules.
• Symptoms include nausea, abdominal cramps, oliguria, and laboratory evidence of metabolic derangements.
• The timing (soon after chemotherapy) and lab findings are the key differentiators.

Why Other Options Were Wrong

• Option B: SIADH causes hyponatremia and fluid retention, not hyperuricemia or hyperkalemia.
• Option C: Diabetes insipidus (deficient ADH) presents with polyuria and hypernatremia, not oliguria or the metabolic derangements seen in TLS.
• Option D: Dehydration alone does not explain the combination of hyperuricemia, hyperkalemia, and acute kidney injury after chemotherapy.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Recognition of tumor lysis syndrome as an oncologic emergency after chemotherapy in acute care settings.
• Nurses must monitor for TLS in patients with hematologic malignancies starting chemotherapy to prevent fatal complications.
• Prompt recognition and intervention (hydration, medications to lower uric acid and potassium) can prevent renal failure and arrhythmias.
• What if? If the patient had hyponatremia and concentrated urine instead, SIADH would be more likely than TLS.

How to Approach the Question

• Read the clinical scenario carefully for timing and context (recent chemotherapy, hematologic malignancy).
• Identify the key laboratory abnormalities: hyperuricemia, hyperkalemia, elevated creatinine, oliguria.
• Recall the classic features and timing of tumor lysis syndrome.
• Rule out other causes by matching symptoms and labs to each option.
• Select the emergency that best fits the metabolic and renal findings after cytotoxic therapy.

Concept Tested & Keywords

• Concept Tested: Recognition of tumor lysis syndrome as an oncologic emergency after chemotherapy
• Stem keywords: systemic chemotherapy, hematologic malignancy, nausea, abdominal cramping, oliguria, hyperuricemia, hyperkalemia, elevated serum creatinine
• Lead-in keywords: most likely experiencing
• Clinical cues: recent chemotherapy
• Clinical cues: hematologic cancer

Question ID

QPrxjOhV8XbuLMPdTy9GHv

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 1 p. 634-636

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 79-81

E6 Medicine Davidson Principles Practice 24e p. 1348-1350