Question of the Week

For March 14, 2023

A 54-year-old man is evaluated after developing acute kidney injury while receiving cisplatin chemotherapy following resection of a T3N0M0 stage IIB non–small-cell lung cancer.

Laboratory results are notable for a blood urea nitrogen level of 54 mg/dL (reference range, 10–20) and a serum creatinine level of 4.6 mg/dL (0.8–1.3). At his previous evaluation 4 weeks ago, his blood urea nitrogen level was 14 mg/dL, and his serum creatinine level was 0.8 mg/dL.

Initial review of the patient’s records reveals that he did not receive the necessary intravenous volume expansion with the cisplatin chemotherapy. The treating health care provider wrote the order for 1000 mL of intravenous saline to be given during the several hours prior to cisplatin administration, but for some reason that fluid bolus was not administered.

Which one of the following next steps is most appropriate for the treating health care provider?

Explain that nephrotoxicity is a known side effect of cisplatin
Explain the error now, and apologize to the patient
Postpone discussion of the error with the patient until a full investigation of the circumstances leading to the error has been completed
Get advice from the hospital’s ethics consult service
Ask the hospital attorney to meet with and apologize to the patient

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