Your 53 year old male patient seems very vague and his partner tells you that he has been very forgetful and low in mood recently. He feels weak and achey and has to force himself to go downstairs to eat. He has not left the house for 2 weeks. 

He can’t remember when he last opened his bowels but he is thirsty so is drinking and peeing plenty.  He doesn’t really know if he has lost any weight. He has felt under the weather for a few months now.

He had a back injury 8 months ago.  He can’t really remember what happened, just that it seems to have gotten worse rather than improved over time. 

Medication: Paracetamol and ibuprofen for back pain

Examination: No organomegaly or lymphadenopathy

Bloods:

FBC: Hb 78g/L but otherwise fairly normal.

Blood film: some rouleaux but otherwise fairly unremarkable.

Retics 84

LFTs normal

Cre 284

Urea 15.2

Haptoglobin normal

Coombs test negative

Ferritin, B12 and folate normal

CRP 14

What is on your list of differentials for hypercalcaemia?

Why is hypercalcaemia an emergency?

How do you manage hypercalcaemia?