A 37-year-old man with no significant past medical history was referred to the emergency
department due to severe and sudden onset back pain. He also complained of weakness,
nausea, and an episode of vomiting in the last 3 days. On examination he appeared
ill with dry mucous membranes and poor skin turgor. He weighed 59 kg and had a height
of 1.73 m (body mass index 19.7). He had a blood pressure of 130/80 mmHg, heart rate
of 90 beats per min, temperature of 36.6 degrees Celsius, and O2 saturation of 99%.
On palpation, marked tenderness was elicited over the right posterior aspect of the
rib cage and small (up to 1 cm) but firm lymph nodes were palpated in the inguinal
region bilaterally. Blood tests revealed hypercalcemia of 22.3 mg/dL and undetectable
parathyroid hormone levels, creatinine of 1.6 mg/dL, urea of 63 mg/dL, and phosphorus
of 4.4 mg/dL. He was treated with intravenous saline followed by furosemide, intravenous
pamidronate and subcutaneous calcitonin. Adequate urine output was maintained, and
serum calcium dropped to 13 mg/dL within 24 hours and to 10.1 md/dL within 3 days.
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References
- Hypercalcemia: a review.JAMA. 2022; 328: 1624-1636
- Extreme hypercalcemia in a kidney transplant recipient.CEN Case Rep. 2018; 7: 229-233
- An unusual case of severe hypercalcemia: as dehydrated as a bone.J Community Hosp Intern Med Perspect. 2021; 11: 135-138
Article info
Publication history
Published online: February 02, 2023
Accepted:
January 20,
2023
Received:
January 19,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
