Along with knowledge of how to evaluate a pediatric patient with a suspected malignancy, general pediatricians must maintain a high level of suspicion of tumor lysis syndrome for initial management and timely patient referral. This syndrome is largely preventable, and certainly manageable, with prompt diagnosis and appropriate intervention.

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Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency that occurs when cancer cells break down, either spontaneously or after initiation of cytotoxic chemotherapy, and release their intracellular contents into the bloodstream. This massive release of uric acid, potassium, and phosphorous, which under normal physiologic conditions are excreted in the urine, can lead to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. These metabolic derangements increase the risk of severe complications, including acute kidney injury (AKI), cardiac arrhythmias, seizures, and even death. TLS is the most common oncologic emergency, and it occurs most frequently in children...

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