Hypercalcemia, Severe

Thirsty

Step 1: View clinicals

A 72 year old man presents with fatigue, weakness, thirst and polyuria for 1 month. He appeared to be in good health prior to this. His medical, surgical and family histories are unremarkable and he is not on any drugs. He does not smoke, and drinks only at social events. His ESR is found to be 130 mm/1h.


Step 2: Order all relevant investigations

Fasting Blood Glucose

His fasting blood glucose is 90 mg/dl (normal: 70 - 110)

Serum Electrolytes

Na+: 139 mEq/l K+: 4.5 mEq/l Cl-: 97 mEq/l Ca++: 14.1 mg/dl (range: 8.8 - 10.3) PO4---: 3.5 mg/dl (range: 3.4 - 4.5)

Renal & Liver functions

S. Creatinine: 1.5 mg/dl (range: 0.5 - 1.5) ALT: 35 IU/l (normal) AST: 28 IU/l (normal) ALP: 47 IU/l (normal) Albumin: 3.5 g/dl (normal) Globulin: 5.8 g/dl (range: 2.3 - 3.5)

Full Blood Count

WBC/DC: 5,000/mm3 Hb: 9 mg/dl MCV: 89 fl Platelets: 190,000/mm3 The blood film shows marked rouleaux formation.


Step 3: Select appropriate management

Insulin
IV fluids
Pamidronate
Melphalan


Score: ★★☆