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
Click to Reveal the Correct Answer
