Preventing Tumor Lysis Syndrome: Two Case Studies of Unexpected Outcomes.

BACKGROUND Tumor lysis syndrome (TLS) is a potentially fatal complication in patients with large, rapidly proliferating tumor cell cancers that may occur after chemotherapy. Patients with TLS are complicated to treat and often have an unpredictable trajectory. OBJECTIVES The purpose of this article is to report two cases with unusual clinical manifestations and unexpected outcomes during cancer treatment and to share best practices for this situation. METHODS The authors described details from two unusual cases and outlined lessons learned. The authors described a newly developed clinical order set (protocol) to support optimal care for patients at risk for TLS. FINDINGS Implementing best practices, the order set prompts early identification of TLS risk and provides step-by-step guidance to eliminate or control TLS.