A 72-year-old man presented to the emergency department with a 3-day history of slurred speech, altered mental status, and unstable gait.
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?
Final Publication and Comments
The final published version with discussion and comments from the experts appears in the July 2019 issue of Clinical Chemistry, approximately 3-4 weeks after the Student Discussion is posted.