A medically complex 10-month-old boy with lethargy

摘要

A 10-month-old boy status-post hematopoietic stem cell transplant for leukemia, with type IV renal tubular acidosis secondary to cyclosporine and resolved hypertension, presents to the emergency department with lethargy. He had been difficult to awaken since this morning. His family denies fever, other symptoms suggestive of infection, or trauma. Current medications include cyclosporine, sulfamethoxazole/trirnethoprim, and citric acid. His family denies any possibility of unintentional toxic ingestion.