63 year old lady with abdominal pain and mild confusion

Samuel Wilson on May 26, 2013
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Here are the results of the labs you ordered:

BMP
139
4.1
105
38
1.2
24
94
Ca14.4
Mg0
Phos0
CBC
7.1
12.1
37.1
210
Liver Enzymes
AST 29
ALT 34
Alk 110
Bilirubin (total) 1.1
Bilirubin (direct) 0.7
albumin 4.1

After reviewing the lab results, what would be the most appropriate next step for Ms. Moore?

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Admit her for further management
Correct. The severity of the hypercalcemia as well as the symptoms she is experiencing is concerning and thus she should be admitted for further management.


Instruct her to increase her fluid intake as she is intravascularly dry and schedule a follow up appointment in one week
Incorrect. Oral fluid intake is unlikely to be adequate to address the hypercalcemia. Given her symptoms, outpatient management would not be suitable for her.


Pursue imaging/extra laboratory studies to investigate underlying cause of hypercalcemia
Incorrect. However, this should be done after the hypercalcemia is addressed.


Start a calcium lowering agent such as bisphosphonates or calcitonin
Incorrect. Although these therapies can reduce serum calcium, something else must be done first before administering these medications.


Uncheck All Answers

Here are the results of the labs you ordered:

BMP
139
4.1
105
38
1.2
24
94
Ca14.4
Mg0
Phos0
CBC
7.1
12.1
37.1
210
Liver Enzymes
AST 29
ALT 34
Alk 110
Bilirubin (total) 1.1
Bilirubin (direct) 0.7
albumin 4.1

After reviewing the lab results, what would be the most appropriate next step for Ms. Moore?

Expand all answers
Admit her for further management
Correct. The severity of the hypercalcemia as well as the symptoms she is experiencing is concerning and thus she should be admitted for further management.


Instruct her to increase her fluid intake as she is intravascularly dry and schedule a follow up appointment in one week
Incorrect. Oral fluid intake is unlikely to be adequate to address the hypercalcemia. Given her symptoms, outpatient management would not be suitable for her.


Pursue imaging/extra laboratory studies to investigate underlying cause of hypercalcemia
Incorrect. However, this should be done after the hypercalcemia is addressed.


Start a calcium lowering agent such as bisphosphonates or calcitonin
Incorrect. Although these therapies can reduce serum calcium, something else must be done first before administering these medications.


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