Two cases of acute tumor lysis syndrome occurring in patients with hepatocellular carcinoma are reported. Both patients were treated with transcatheter chemoembolization. Tumor lysis syndrome was not anticipated in the first case and was diagnosed late. However, the second patient's syndrome was detected early and treated appropriately. Subtle changes in electrolytes may be missed because of aggressive hydration that many of these patients receive because of cisplatin therapy. I propose that all patients with large hepatoma, particularly those with a short history, be monitored closely for acute tumor lysis syndrome.
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