We describe a child who developed acidosis, hyperkalaemia and cyanosis while emerging from an otherwise uneventful anaesthetic. A diagnosis of tumour lysis syndrome was suspected and confirmed biochemically. Although this syndrome is usually associated with chemotherapy and has been described to occur spontaneously, it has not previously been reported as being associated with anaesthesia.

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Summary We report a case of spontaneous tumour lysis syndrome that developed postoperatively in a patient with undiagnosed Burkitt’s lymphoma. The former diagnosis was made, unusually, following the development of white emulsion‐like urine in the catheter bag whilst the patient was being managed in the intensive care unit. After laboratory analysis, the urine was found to contain large quantities of uric acid crystals which were the key to the prompt diagnosis. Spontaneous tumour lysis syndrome is rare and this case highlights the difficulties in making an early diagnosis when the presence of a predisposing tumour has not yet been identified. Untreated tumour lysis syndrome can be fatal due to severe biochemical disturbances causing cardiac dysfunction and multi‐organ failure. Early recognition and treatment are crucial to prevent morbidity and mortality. The unusual presentation of this case in association with an undiagnosed Burkitt’s lymphoma emphasises how vigilant anaesthetists and intensivists must be in recognising this potentially life‐threatening condition. We believe that the triggering factor in this case was laparotomy and handling of the tumour.

Transfer of the critically ill adult is an integral part of working life for intensive care staff in Wales and the rest of the UK. The numbers of inter-hospital transfers have been increasing year on year (approximately 550 last year) due to greater pressures on intensive care beds and greater specialisation at tertiary centres. Transfers have traditionally taken place in an ad hoc way with poor co-ordination between the stakeholders. In the North Wales Critical Care Network (NWCCN), holistic steps have been taken to improve the service and have succeeded in making the process of transfer safer. Although this work has been led by the network, it has been approached in a collaborative way working closely with the South East Wales Network (SECCN) and the Mid- and West- Wales Network (MWCCN), as well as the Welsh Ambulance Service, Welsh Air Ambulance and the Royal Air Force search and rescue. This article describes the process.

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