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Nurses' Notes 2200: The client is 18 hours after the first chemotherapy dose for bulky Burkitt lymphoma. At 2210, the chemistry panel shows that serum potassium increased to 6.1 mEq/L from 4.2 mEq/L. The handoff notes that nausea improved and no vomiting recurred after the prescribed antiemetic was given. The pretreatment report confirms that uric acid was 5.8 mg/dL on the completed panel before chemotherapy began. The current panel shows that serum phosphorus increased to 6.8 mg/dL from 3.7 mg/dL. The nurse verifies that serum calcium was 9.1 mg/dL on the completed pretreatment panel. At 2215, the flow sheet shows that urine output falls to 12 mL/hr while creatinine rises to 2.1 mg/dL. The intravenous assessment confirms that prescribed hydration is infusing through a patent line without alarms or leakage and the programmed hourly volume is displayed correctly. Telemetry currently shows that sinus rhythm continues without premature complexes on the bedside monitor. The client also reports that fatigue is unchanged from handoff and has continued since the chemotherapy session ended. At 2220, the client reports that new perioral tingling occurs with visible carpal spasm. The nurse places the client on continuous monitoring and immediately reports suspected tumor lysis syndrome. Repeat electrolyte testing and emergency treatment are prepared as prescribed.