Q: 44 year old female is transferred from Oncology floor with mental status change and found to be in Tumor Lysis Syndrome (TLS). What is the indication for hemo-dialysis (HD)? (select one)

A) Calcium-phosphate product more than or equal to70 mg2/dL
B) Calcium level of 11 mg/dL
C) Vitamin D level of 22 ng/mL
D) Parathyroid level of 110 pg/mL
E) Unavailability of bisphosphanate 



Answer: A

Tumor Lysis Syndrome is potentially an avoidable situation and may become fatal without adequate preparation in advance in tumors known to cause TLS. Hydration, Furosemide, electrolyte and uric acid management are the cornerstone of TLS. 

HD becomes an indication in severe oliguria/anuria, persistent hyperkalemia, Calcium-phosphate product more or equal to70 mg2/dL2 and calcium level above 18 mg/dL.