Multiple Problems
67 y/o M presents with back pain, generalized fatigue, anorexia, nausea & vomiting. Exam reveals: altered mental status and profound volume depletion. Labs reveal normocytic anemia, acute renal failure, hypokalemia 2.9, hypercalcemia to 14 and hypergammaglobinemia. Imaging reveals lytic lesions in T10. Pt on initial presentation was noted to have severe hypercalcemia with resultant diabetes insipidus and hypokalemia in the setting of likely malignancy. Multiple Myeloma diagnosed on SPEP/ UPEP and BM biopsy.
Important Points discussed: 1) Clinical Presentation of Hypercalcemia 2)Treatment options: FlUIDS FLUIDS and when to start bisphosphanates early. 3) Etiology of renal failure in the setting of multiple myeloma, with 2 reversible causes being hypercalcemia and hyperuricemia. 4) Importance of PO phosphate repletion over IV 5) Clinical manifestation and diagnostic studies for multiple myeloma.