Related Cases:
|Case #1 Potassium
|Case #2 Calcium
|Case #3 Calcium
|Case #4 Glucose
|Case #5 Shakes
|Case #6 Weakness
|Case #7 Headache
|Case #8 Weakness
|Case #9 Weakness
|Case #10 Weakness
|Case #11 Weak face
|Case #12 Weak eyes
|Case #13 Shakes
|Case #14 Confusion
|Case #15 Headache
|Case #16 Breathless
|Case #17 Unconscious
|Case #18 Breathless
|Case #19 Weakness
|Case #20 Breathless
A 72-year-old lady who is a former shopworker presents through the emergency department with breathlessness and malaise over the past 4 weeks. She is dehydrated. She has lost 5 kg in weight in one month. She has been a smoker since her teens approximately 55 pack years. She continues to smoke. Her blood tests are as follows
Initially rehydration would be the treatment of choice. She would need at least 3-4 L of fluids in the first 24 hours and then recheck the calcium level. Once she has been rehydrated and if renal function improved then an infusion of IV Pamidronate or Zoledronate in the next few days would be appropriate.
She likely has a PTH related peptide being secreted by the lung tumour which is classically a non-small cell lung cancer squamous cell and this therefore raised calcium levels.
We need more information to make a diagnosis of lung cancer and that would include a staging CT scan of chest and abdomen and a bronchoscopy. It is always important to get a confirmatory tissue biopsy where possible. The CT scan confirms a right upper zone mass with some spread to hilar lymph nodes. A biopsy confirms squamous cell cancer.
Answer
Chemistry Value Range Serum Sodium 145 137 - 144 mmol/L
Serum Potassium 4.0 3.5 - 4.9 mmol/L
Serum Chloride 100 95 - 107 mmol/L
Serum Urea 15 2.5 - 7.5 mmol/L
Serum Creatinine 120 60 - 110 micromol/L
Serum corrected Calcium 3.4 2.2 - 2.6 mmol/L
Serum Phosphate 0.7 0.8 - 1.4 mmol/L
1. What test would you like next
There is a right upper zone opacity
2. How would you manage her hypercalcaemia
3. What is the mechanism of the high calcium
4. What further tests would you arrange
5. Question
6. Question
7. Question
References
MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd |
Case #2 Calcium
-
| About | Anaesthetics and Critical Care | Anatomy | Basic Science | Biochemistry | Cardiology | Cases | Clinical Cases | Crib | Dentistry | Dermatology | Differentials | Drugs | ENT | Electrocardiogram | Embryology | Emergency Medicine | Endocrinology | Ethics | Foundation Doctors | Gastroenterology | General Information | General Practice | Genetics | Geriatric Medicine | Guidelines | Haematology | Hepatology | Immunology | Infectious Disease | Infectious Diseases | Infographic | Investigations | Lists | Microbiology | Miscellaneous | Nephrology | Neuroanatomy | Neurology | Nutrition | OSCE | Obstetrics Gynaecology | Oncology | Ophthalmology | Oral Medicine | Paediatrics | Palliative | Pathology | Pharmacology | Physiology | Procedures | Psychiatry | Radiology | Research | Respiratory | Resuscitation | Rheumatology | Statistics | Stroke | Surgery | Surgical | Toxicology | Trauma and Orthopaedics | Twitter | Urology | Version Jan 2023