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A 9-year-old girl being treated with combination chemotherapy for acute lymphoblastic leukemia (ALL) is noted to have increased levels of blood urea nitrogen (BUN) and creatinine on day 4 of treatment. The patient is immediately started on intravenous normal saline. An ECG is ordered which demonstrates prolonged QT intervals. For confirmation of the diagnosis, several laboratory tests, including a complete metabolic profile, are ordered. Which of the following laboratory abnormalities result from this patient's condition?

Question

A 9-year-old girl being treated with combination chemotherapy for acute lymphoblastic leukemia (ALL) is noted to have increased levels of blood urea nitrogen (BUN) and creatinine on day 4 of treatment. The patient is immediately started on intravenous normal saline. An ECG is ordered which demonstrates prolonged QT intervals. For confirmation of the diagnosis, several laboratory tests, including a complete metabolic profile, are ordered. Which of the following laboratory abnormalities result from this patient's condition?

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Solution

The patient's condition, as described, suggests that she may be experiencing tumor lysis syndrome (TLS). This is a potentially life-threatening disorder that can occur after treatment for certain types of cancer, such as acute lymphoblastic leukemia (ALL). It is caused by the rapid release of cellular contents into the bloodstream, either spontaneously or in response to chemotherapy, which can lead to electrolyte and metabolic disturbances.

The laboratory abnormalities that can result from TLS include:

  1. Hyperkalemia (high potassium levels): This is due to the release of intracellular potassium into the bloodstream following cell lysis. This can affect heart function and cause changes in the ECG, such as prolonged QT intervals.

  2. Hyperphosphatemia (high phosphate levels): This is also due to cell lysis. Excess phosphate can bind to calcium in the blood, leading to hypocalcemia (low calcium levels).

  3. Hyperuricemia (high uric acid levels): This is due to the breakdown of nucleic acids following cell lysis. High levels of uric acid can lead to kidney damage, as indicated by the increased levels of blood urea nitrogen (BUN) and creatinine.

  4. Hypocalcemia (low calcium levels): This can occur when excess phosphate binds to calcium in the blood.

  5. Acute kidney injury: This can occur due to the deposition of uric acid crystals in the kidneys, leading to increased BUN and creatinine levels.

Therefore, the laboratory abnormalities that can result from this patient's condition include hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and acute kidney injury.

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