title: Preventing Tumor Lysis Syndrome: Two Case Studies of Unexpected Outcomes.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  Implementing best practices, the order set prompts early identification of TLS risk and provides step-by-step guidance to eliminate or control TLS.
authors.affiliation: Texas Health Arlington Memorial Hospital.
authors.forename: Martha R
authors.initials: MR
authors.lastname: Sleutel
authors.affiliation: Texas Health Arlington Memorial Hospital.
authors.forename: William
authors.initials: W
authors.lastname: Brown
authors.forename: Jo Nell
authors.initials: JN
authors.lastname: Wells
mesh_terms: D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004638:Emergency Treatment / Q000379:methods; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D015275:Tumor Lysis Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D014503:Urate Oxidase / Q000627:therapeutic use*
chemical_list: C469709:rasburicase; D000493:Allopurinol; D014503:Urate Oxidase
keywords: methemoglobinemia; nursing care; rasburicase; tumor lysis syndrome