8/2 Morning Report w/ Kat Iwata: Hypercalcemia

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!

-PTH

-PTHrP

-1,25 Vit D for granulomatous process (sarcoid)

-25 Vit D level for vitamin D toxicity

-SPEP/UPEP

DDx

-Malignancy

-Multiple Myeloma

-Milk Alkali Syndrome

-Hyperparathyroidism

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).

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