How to Prevent Renal Dysfunction During Chemotherapy
Faustine Ramirez
In Episode 59 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question:
A 12-year-old boy with a new diagnosis of ALL is admitted to the hospital for chemotherapy induction. On day 2 of the hospitalization he starts complaining of tingling around his mouth. He also reports cramping of his hands and feet. He feels anxious and very fatigued. He last voided 8 hours ago. Temperature is 37.3 C, heart rate is 122/min, respiratory rate is 20/min, and blood pressure is 118/73. On examination he has generalized mild muscle weakness and periodic spontaneous muscle twitching. Laboratory studies show:
Sodium – 137
Potassium – 6.2
Chloride – 103
Creatinine – 1.9
Glucose – 102
Phosphorus – 7.3
Calcium – 6.5
Bicarbonate – 21
BUN – 30
Uric acid – 9.8
EKG shows a PR interval of 220 msec and sharp pointed T waves. He is receiving two times maintenance IV fluid hydration. In addition to IV fluids, which of the following could have helped prevent the renal dysfunction?
