Electrolyte disturbances Quiz: Ace Your Exams

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A 67-year-old female presents to the emergency department with nausea, vomiting, and lethargy. The patient is currently undergoing treatment for diffuse large B-cell lymphoma and last received chemotherapy two days ago. The patient’s temperature is 37.0°C (98.6°F), pulse is 121/min, respirations are 18/min, blood pressure is 92/74 mmHg, and O2 saturation is 94% on room air. On physical exam, she is pale and ill-appearing, intermittently convulsing, and has tenderness to palpation over the left flank. Laboratory findings are demonstrated below:  


Which of the following metabolic derangements best explains this patient's clinical presentation?

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