What are the recommended management strategies for a patient diagnosed with Tumour Lysis Syndrome in a primary care setting?

In a primary care setting, the management of a patient diagnosed with Tumour Lysis Syndrome (TLS) focuses primarily on urgent recognition, initial supportive care, and prompt referral to secondary or tertiary care for definitive management.

Immediate actions include:

• Recognising TLS as a medical emergency characterized by rapid release of intracellular contents leading to hyperuricaemia, hyperkalaemia, hyperphosphataemia, and hypocalcaemia, which can cause acute kidney injury and cardiac arrhythmias NICE NG219 Coiffier et al. 2008.
• Initiating aggressive intravenous hydration to maintain high urine output and facilitate renal clearance of electrolytes and uric acid, unless contraindicated by cardiac or renal comorbidities NICE NG219 Coiffier et al. 2008.
• Monitoring vital signs and symptoms closely, including cardiac monitoring if hyperkalaemia or arrhythmias are suspected NICE NG219 Coiffier et al. 2008.
• Avoiding nephrotoxic drugs and correcting electrolyte imbalances cautiously while awaiting specialist input NICE NG219 Coiffier et al. 2008.
• Urgently referring the patient to hospital for further management, including laboratory monitoring of electrolytes, renal function, and initiation of specific treatments such as rasburicase or allopurinol, which are not typically initiated in primary care NICE NG219 Coiffier et al. 2008.

In summary, primary care management of TLS is supportive and stabilising, with rapid recognition and urgent referral being critical to prevent life-threatening complications.