M.D. has now completed three cycles of CAF, with her last treatment being approximately 12 days ago
She comes to the emergency department with a 2-day history of fever, chills, and shortness of breath. On
arrival, she is disoriented and agitated.
Vital signs are 86/43, 119, 28, 103.6 ° F (39.8 ° C), Spo2 85% on room
air. The chest x-ray examination demonstrates diffuse infiltrates in the left lower lung. Her basic metabolic
panel (BMP) is within normal limits, with the exception of blood urea nitrogen (BUN) 28 mg/dL, creatinine
1.6 mg/dL, and lactic acid 2.4 mg/dL.
Interpret M.D.'s laboratory results and explain the rationale for abnormal results.
• Myelosuppression from the chemotherapy is the cause of the decreased WBCs, Hgb, Hct, and
platelet count.
• Her lymphocyte count is elevated; it should be 24% to 44%. This is consistent with pneumonia.
• The elevated BUN and creatinine indicate probable dehydration because of vomiting and indicate
a potentially developing renal insufficiency.
• The elevated lactic acid level is a by-product of anaerobic metabolism. With pneumonia in her
left lower lobe and decreased availability of oxygen, cells are required to manufacture adenosine
triphosphate (ATP) using the anaerobic pathway.
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