A 34 year-old female presents to the emergency room with nausea, vomiting, loss of appetite, extreme weakness, decreased urine output, tingling around her lips, chest pain, palpitations and depressive mood. She was recently diagnosed with Burkitt’s lymphoma and was started on an aggressive rituximab therapy a few days ago. Her past medical history is significant for glucose-6-phosphate dehydrogenase deficiency. She is breast feeding her one-year old baby boy. In physical examination, you notice an anxious individual having some difficulty in breathing, tachycardia and decreased muscle strength. When you tap over the facial nerve in front of the ear you notice ipsilateral contraction of the facial muscles. Laboratory results are given below: Test Result Reference range Potassium (K⁺) 7.7 mEq/L 3.5 – 5.0 mEq/L Calcium 5.6 mg/dL 8.4 – 10.2 mg/dL Uric acid 10.7 mg/dL 3.0 – 8.2 mg/dL Phosphorus 5.2 mg/dL 3.0 – 4.5 mg/dL Creatinine 4.6 mg/dL 0.6 – 1.2 mg/dL Urea nitrogen 27 mg/dL 7 – 18 mg/dL Lactate dehydrogenase 743 U/L 45 – 200 U/L EKG showed QRS prolongation with peaked T waves. Which of the following medications could have a prominent role in the prevention of tumor lysis syndrome in this patient?

A 32 year-old female presents to the emergency room with nausea, vomiting, loss of appetite, extreme weakness, decreased urine output, tingling around her lips, chest pain, palpitations and depressive mood. She was recently diagnosed with Burkitt’s lymphoma and was started on an aggressive rituximab therapy a few days ago. Her past medical history is significant for glucose-6-phosphate dehydrogenase deficiency. She is breast feeding her one-year old baby boy. In physical examination, you notice an anxious individual having some difficulty in breathing, tachycardia and decreased muscle strength. When you tap over the facial nerve in front of the ear you notice ipsilateral contraction of the facial muscles. Laboratory results are given below: Test Result Reference range Potassium (K⁺) 7.7 mEq/L 3.5 – 5.0 mEq/L Calcium 5.6 mg/dL 8.4 – 10.2 mg/dL Uric acid 10.7 mg/dL 3.0 – 8.2 mg/dL Phosphorus 5.2 mg/dL 3.0 – 4.5 mg/dL Creatinine 4.6 mg/dL 0.6 – 1.2 mg/dL Urea nitrogen 27 mg/dL 7 – 18 mg/dL Lactate dehydrogenase 743 U/L 45 – 200 U/L EKG showed QRS prolongation with peaked T waves. Of the following, which is the most likely diagnosis in this patient?

A 27 year-old female comes to your office and reports a ‘migraine attack’, sore throat and dark urine color. She is 2 months pregnant. She takes acetaminophen 500 mg twice daily as needed for pain in her back. She has not been taking folate or any other vitamin supplements. She takes propylthiouracil for hyperthyroidism. On further questioning, she reveals she also has abdominal pain and swelling of the legs. On physical examination, you notice yellow eyes and skin along with abdominal tenderness in the right upper quadrant. Her temperature is 101 °F (38.3 °C), heart rate is 108 beats/min, blood pressure is 100/70 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 98% on room air. What is the next best step in the management of this patient?

A 34-year-old female presents with recurrent bruising, petechiae, and intermittent epistaxis. Laboratory workup reveals severe thrombocytopenia with a platelet count of 18,000/μL. She has a history of immune thrombocytopenia (ITP) refractory to corticosteroids and intravenous immunoglobulin (IVIG). After failed medical management, the patient undergoes a laparoscopic splenectomy. Postoperative recovery is uneventful, and her platelet count stabilizes within the normal range. Which of the following is the most feared complication after splenectomy?