How to Prevent Renal Dysfunction During Chemotherapy

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?

• Calcium gluconate
• Calcium chloride
• Furosemide
• Colchicine
• Rasburicase
• Sodium bicarbonate
• Allopurinol