A 46-year-old man with newly diagnosed Burkitt lymphoma is admitted for initiation of chemotherapy. He has a large mediastinal mass, extensive abdominal lymphadenopathy, and a serum LDH of 1900 U/L. His baseline labs reveal a uric acid of 8.2 mg/dL, creatinine of 1.4 mg/dL, potassium of 4.9 mmol/L, phosphate of 4.3 mg/dL, and calcium of 8.6 mg/dL. He is started on aggressive IV fluids and allopurinol. Within 18 hours of starting chemotherapy, he becomes confused and tachycardic. Repeat labs show potassium 6.4 mmol/L, phosphate 6.5 mg/dL, calcium 6.8 mg/dL, uric acid 12.5 mg/dL, and creatinine 2.3 mg/dL.
Time's up
