Case #5:

An 80-year-old lady without any known medical history is evaluated in the Emergency Room and found to be obtunded. Her family reports increasing constipation and non-specific abdominal pain over the previous month. She has also been having more episodes of urinary incontinence. Aside from her altered mental state, her exam is notable for temporal wasting and a grade II decubitus ulcer on her sacrum. Her lung exam is normal, but she has a harsh, 3/6 midsystolic murmur heard throughout the precordium. Her abdomen is diffusely tender. The nurses draw STAT labs and send her to the CT scanner. Initial review of the CT scan of the head is normal.

Labs

Calcium: 16.4          Potassium: 5.0
PTH: 2ng/L (low)      Chloride: 109
Phosphorus: 3.2      Bicarbonate: 16
Sodium: 148
Creatinine: 4.8 (baseline 0.9)