A 22-year-old man with a history of recurrent osteosarcoma presents with weakness and lethargy following a recent course of chemotherapy. He described himself as ‘tired and washed out’ and feels like his muscles are generally weak. He has had difficulty walking any distance and getting from sitting to standing. He has not had any focal neurological symptoms nor any systemic or localizing symptoms suggestive of infection.
His current medications include amphotericin lozenges and omeprazole. Examination shows that he is afebrile. Examination Pulse: 80 bpm BP:120/70 mmHg RR: 15 rpm O 2 saturation: 98% s/v air Chest clear, abdomen soft, non-tender No organomegaly Investigations Hematological parameters: Hb 10.5 g/dL; WBC 3.3 × 10 9 /L; Platelets 164 × 10 9 /L Biochemical parameters: Na 137 mmol/L; K 2.5 mmol/L; Urea 5.3 mmol/L; Creatinine 90μmol/L; Cl 116 mmol/L ABGs: pH 7.24; HCO 3 9 kPa;…
