Case Published: July 2020

History of Present Illness (HPI)

A 57-year-old woman with a past medical history of bipolar disorder and hyperlipidemia is admitted to the hospital to start chemotherapy for a new diagnosis of acute myeloid leukemia (AML).

Prior to admission she notes fatigue that has progressed since her AML diagnosis, but has otherwise been feeling well. She does not have chest pain, shortness of breath, light-headedness, syncope, nausea, vomiting, abdominal pain, diarrhea, constipation, lower extremity edema, or rashes. She has a several year history of frequent urination without dysuria, hematuria, or hesitancy. She drinks several bottles of water per day and gets up approximately 3 times per night to urinate. Her medications include lithium for the past 20 years and simvastatin for the past 10 years. She does not take over the counter medications or supplements. She denies any known personal or family history of kidney disease.

On admission she starts chemotherapy with cytarabine and daunorubicin. Over the course of her admission she develops neutropenic fever, nausea/vomiting, diarrhea, mucositis and thrush. Her appetite is poor. She receives intravenous (IV) cefepime and fluconazole. She has intermittently received IV normal saline boluses for low blood pressures.

Two weeks into her admission, Nephrology is consulted for abnormal labs.

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