An elderly gentleman with a pmh of CAD who presented with 6 months of progressive confusion and global weakness admitted for hypercalcemia also found to have a new anemia and AKI.
Know workup of hypercalcemia – think about malignancy in hospitalized patients!
-1,25 Vit D for granulomatous process (sarcoid)
-25 Vit D level for vitamin D toxicity
-Milk Alkali Syndrome
Acute treatment of hypercalcemia -> fluids, fluids, fluids — In this case aggressive fluid resuscitation threw this patient into pulmonary edema. Remember that pamidronate takes 2-3 days to work.
Update: SPEP came back with M spike and increased lamda light chains highly suggestive of multiple myeloma. He is now out of the ICU and s/p bone barrow biopsy to seal the diagnosis. (To diagnose multiple myeloma you need a bone marrow biopsy looking for > 10% clonal plasma cells).