<prompt> All are true regarding Tumor lysis syndrome except:HypercalcemiaHypocalcemiahyperphosphatemiaHyperkalemia  <response>: Ref: Harrisons Principles of Internal Medicine, 18,th edition, pg 2274Explanation:Tumor lysis syndrome TLSCharacteristic biochemical changes in Tumor lysis SyndromeHyperuricemia,Hyperkalemia,Hypocalcemia,Hyperphosphatemia.AcidosisAcute renal failure.Caused by destruction of large number of rapidly multiplying neoplastic cells: During Burkins lymohoma. ALL. CLL on chemotherapyChemotherapy commonly associated are-Fludarabine.Letrozole,Tamoxifen.Glucocorticoids,RituximabGemtuzumabAcute hyperurecemic nephropathy- urinary uric acid ! urine creatinine 1High calcium:phosphate ratio - renal failureTumor burden, hyperuricemia high LDH - high risk for TLS.TreatmentAllopurinolRasburicase recombinant urate oxidase: contraind in G6PD deficiency, can cause bronchospasm, hypotension hypoxiaAggressive hydration with Vi NSUrinary alkalinization with pH 7 with IV sodium bicarbonateHemodialysishemofUtration:If S.potassium 6;S. Uric acid 10.S.Phosphate 10.S.Creat 10 with severe hypocalcemiaCauses of hypercalcemia: VITAMINS TRAPVitamin D, A intoxication. VIPomaImmobilisationThiazide. TPNAddisonsMilk-alkali syndromeInfection: TuberculosisNeoplasm- Myeloma, secondary depositsSarcoidosisTuberculosis, ThyrotoxicosisRadiationAIDSParathyroid excess- primary tertiary; Pagets 