# A client with a high tumor burden (acute leukemia) is starting induction chemotherapy. Which prophylactic medications prevent tumor lysis syndrome?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391866&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with a high tumor burden (acute leukemia) is starting induction chemotherapy. Which prophylactic medications prevent tumor lysis syndrome?

## Option

1. Administer aggressive intravenous hydration with sodium bicarbonate to maintain urine pH above 7.0 to increase uric acid solubility and prevent precipitation
2. Aggressive IV hydration plus allopurinol (or rasburicase for high-risk/established TLS); monitor K, phosphorus, uric acid, calcium, creatinine **✔ Correct answer**
3. Administer furosemide concurrently with aggressive IV hydration to promote diuresis and enhance renal excretion of uric acid and phosphate
4. Administer intravenous calcium gluconate promptly to correct hypocalcemia and prevent neuromuscular irritability in the setting of hyperphosphatemia

**Correct answer: 2**

## Explanation

Correct (2): Tumor lysis syndrome = massive cell breakdown → hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, AKI. Prophylaxis: aggressive hydration + allopurinol (xanthine oxidase inhibitor); rasburicase (recombinant urate oxidase) for high risk or established TLS — converts uric acid to allantoin. Avoid in G6PD deficiency (hemolysis risk). (1,3,4) Unrelated.

## In-depth explanation

Memory Tip TLS = "Tumor Lyse Syndrome" — K↑, P↑, Uric acid↑, Ca↓. Prophylaxis: HYDRATE + ALLOPURINOL ± RASBURICASE.

## Clinical scenario

Scenario 22-year-old male with new ALL high WBC starting induction chemo; high TLS risk.

## Key concepts

- **Tumor lysis syndrome** — Massive tumor cell death releasing K, P, uric acid; causes AKI and arrhythmia.
- **Allopurinol** — Xanthine oxidase inhibitor; reduces uric acid formation; TLS prophylaxis.
- **Rasburicase** — Recombinant urate oxidase; converts uric acid to allantoin; G6PD deficiency contraindicated.

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