Multiple Choice Questions

Question 23. A man with bulky extensive stage 4B Burkitt's lymphoma commenced systemic combination chemotherapy with R-CODOX-M. One day into treatment he became unwell with hypotension and tachycardia. His serum electrolytes results were:

	Pre Chemo	Day 2 Chemo	Normal range
Sodium	134	129	133-146 mmol/L
Potassium	4.9	5.8	3.5-5.3 mmol/L
Urea	8.0	18.6	2.5-7.8 mmol/L
Creatinine	33	197	60-125 μmol/L
Bilirubin	9	28	0-21 μmol/L
Alanine transaminase	13	13	0-40 IU/L
Alkaline phosphatase	64	64	30-130 IU/L
Corrected calcium	2.51	2.05	2.15-2.60 mmol/L
Phosphate	1.18	2.79	0.8-1.5 mmol/L
Albumin	35	28	35-50 g/L
Haemoglobin	115	106	130-168 g/L
White cell count	7.6	5.7	4.2-10.6 x10⁹/L
Platelets	314	218	130-370 x10⁹/L

What is the most likely cause of hyperkalaemia?

	a. Addisonian crisis
	b. Diabetes mellitus
	c. Febrile neutropenia
	d. Haemolytic anaemia
	e. Tumour lysis syndrome