Case 137 – Update 2

You have treated our gentleman with AKI and hypercalcaemia with IVT and once well hydrated, you added an IV bisphosphonate.  His calcium is a little better at 3.2 and his renal function is also a little better with creating improved to 190.

We discussed that it is important to recognise and treat hypercalcaemia as it can be related to drowsiness, confusion, weakness, constipation, vomiting, polydipsia, polyuria, dehydration, shortened QT interval, prolonged PR interval and arrhythmias.  NICE guidelines suggest admission for urgent management if hypercalcaemia is severe (>3.4mmol/L) or symptomatic. 

We have discussed some of the more common causes of hypercalcaemia and our differential included malignancies, particularly lung cancer, multiple myeloma, and renal cell carcinoma as well as breast and colorectal cancers and also hyperparathryroidism. 

We have finally got back the results we have been waiting for

Bloods: Serum electrophoresis: IgG K paraprotein 13.2g/L, K light chains 9802

MRI whole spine: extensive lytic lesions throughout spine and right clavicle. Compression fracture at T4. No concerns regarding nerve impingement or cord compression.

What is your next course of action?

What further investigations do you need to do?

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