A 72-year-old man presented to the emergency department with a 3-day history of slurred speech, altered mental status, and unstable gait.
Student Discussion Document (pdf)
Paul E. Young, Anthony O. Okorodudu,* and Sean G. Yates
Department of Pathology, University of Texas Medical Branch, Galveston, TX.
*Address correspondence to this author at: Clinical Chemistry Division, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0423. Fax 409-772-9231; e-mail firstname.lastname@example.org
A 72-year-old man presented to the emergency department with a 3-day history of slurred speech, altered mental status, and unstable gait. His family reported a 14-pound weight loss over the past 3 months, along with decreased energy, shortness of breath on exertion, and fatigue. Physical examination was remarkable for generalized weakness, pallor, and tachycardia with a heart rate
of 102 beats per minute. Other vital signs include blood pressure, 149/80 mmHg; temperature, 36.1 °C (97 °F); and respiratory rate, 16 breaths per minute. His medical history was significant for hypertension, hyperlipidemia, and benign prostatic hyperplasia. According to his medical records, a colonoscopy performed 8 years earlier was unremarkable. He had a previous history of smoking (34 pack-years). He had no history of hematochezia or melena.
Initial laboratory results are shown in Table 1. Stool guaiac testing was negative. Brain CT (computed tomography) scan ruled out a cerebrovascular accident, intracranial hemorrhage, or mass lesion in the brain. The patient was managed with intravenous normal saline, calcitonin, and pamidronate for hypercalcemia. He was transfused with 2 units of packed red cells for symptomatic anemia. Extensive workup for the primary cause of hypercalcemia ensued.
Questions to Consider
- What are the signs/symptoms of hypercalcemia?
- What are the differential diagnoses in this patient?
- What is the most probable diagnosis?
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