Tumour lysis syndrome causes all except
**Core Concept**
Tumour lysis syndrome (TLS) is a life-threatening condition that occurs when large numbers of cancer cells die rapidly, releasing their contents into the bloodstream. This leads to a series of electrolyte and metabolic disturbances. TLS is often seen in patients with high tumour burdens, such as acute lymphoblastic leukemia (ALL) or lymphoma.
**Why the Correct Answer is Right**
TLS is characterized by the release of intracellular contents, including potassium, phosphate, and nucleic acids, into the bloodstream. This results in hyperkalemia, hyperphosphatemia, hypocalcemia, and uric acid nephropathy. The uric acid production is due to the breakdown of nucleic acids from the lysed cancer cells. The kidneys are overwhelmed, leading to acute kidney injury.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because TLS does not typically cause hypomagnesemia. In fact, magnesium levels are often normal or elevated in TLS patients.
**Option B:** This option is incorrect because TLS is not primarily associated with a decrease in blood glucose levels. Instead, hyperglycemia is often seen due to the stress response and insulin resistance.
**Option C:** This option is incorrect because TLS is not typically associated with a decrease in blood pressure. In fact, hypertension is often seen due to the hyperkalemia and volume overload.
**Option D:** This option is incorrect because TLS is not typically associated with a decrease in lactate levels. In fact, lactate levels are often elevated due to the anaerobic metabolism of cancer cells.
**Clinical Pearl / High-Yield Fact**
TLS is a medical emergency that requires prompt recognition and treatment. The mainstay of treatment is hydration with IV fluids, followed by allopurinol to prevent uric acid production, and rasburicase to break down uric acid. Early recognition and treatment can prevent serious complications.
**Correct Answer: D.**