Case 10

At the follow-up visit 10 days later, the owners report that Max is breathing a bit better and is slightly more active. In the last two days, however, he has been eating less. There has been no vomiting or diarrhea. He is receiving his medication twice a day as instructed.

Here are his laboratory test results:

CBC

Patient values

Reference range

WBC (/µl)

21,000

3,500-16,000

-Neutrophils (/µl)

17,425

2,500-8,500

-Monocytes (/µl)

1,575

0-600

-Lymphocytes (/µl)

1,350

1,200-8,000

-Eosinophils (/µl)

650

0-1,000

Hct (%)

32

29-48

Hgb (g/dl)

10.4

9.3-15.9

RBC morphology

Normal

Platelets (/µl)

333,000

200,000-500,000

Serum chemistry profile

Patient values

Reference range

BUN (mg/dl)

31

14-36

Creatinine (mg/dl)

1.8

0.6-2.4

Phosphorus (mg/dl)

4.2

2.4-8.2

ALP (IU/L)

115

6-102

ALT (IU/L)

132

10-100

Total bilirubin (mg/dl)

0.2

0.1-0.4

Albumin (g/dl)

2.9

2.5-3.9

Globulin (g/dl)

4.6

2.3-5.3

Glucose (mg/dl)

187

64-170

Calcium (mg/dl)

8.9

8.2-10.8

Sodium (mEq/L)

151

145-158

Potassium (mEq/L)

4.2

3.4-5.6

QUESTION 6

Based on the owner's report and the laboratory results, what do you recommend for Max at this time?

a) Discontinue the fluconazole immediately, and switch him to amphotericin B.

b) Decrease the fluconazole dose by 50%.

c) Discontinue the fluconazole, and start itraconazole.

d) Keep the fluconazole dose the same, and prescribe an appetite stimulant.

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