You are evaluating an HIV-positive patient who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP) pneumonia. Which information is most important to communicate to the physician?

• A. The patient is reporting pain at the site of the infusion.
• B. The patient is not taking in an adequate amount of oral fluids.
• C. Blood pressure is 104/ 76 mm Hg after pentamidine administration.
• D. Blood glucose level is 55 mg/ dL after medication administration.

Answer: (D)

The most important information to report is a markedly low blood glucose after pentamidine administration because this drug can cause hypoglycemia, which can rapidly become life-threatening if not addressed promptly. A reading of 55 mg/dL signals clinically significant hypoglycemia that requires immediate action (give fast-acting carbohydrate if the patient is awake and able to swallow, or use IV dextrose or glucagon if the patient is not cooperative or is unconscious) and recheck glucose after treatment. Communicating this to the physician allows urgent management and potential adjustment of the infusion if needed.

Infusion-site pain is usually expected and manageable, and while inadequate oral fluids can contribute to dehydration or nephrotoxicity, it is not as acutely dangerous as hypoglycemia. A blood pressure of 104/76 mm Hg is not critically low in this context, though it should be monitored. The priority is the hypoglycemia risk, which is why this finding is the most important to communicate.