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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