MedBugs: SAQ #476

Case: Hypercalcaemia

A 56-year-old woman is brought into your tertiary ED by her partner with confusion. Her past history includes hypertension, dyslipidemia and a left mastectomy for Breast Cancer 5 years ago. Her Vital signs are: SaO2 97% RA

BP 124/70 mmHg
HR 114 bpm reg
Temp 36.2 °C
GCS 13 (eye opening/confusion)

You receive an urgent call from the Pathology Lab with her results as below:

Test	Result	Reference range
Bilirubin	84	3 - 15
Alkaline Phosphatase	747	40 - 130
Gamma GT	1371	5 - 35
ALT	114	5 - 30
AST	475	10 - 35
Albumin	23	33 - 44
Globulin	40	23 - 41
Calcium	5.86	2.15 - 2.55
Calcium (corrected)	6.20	2.20 - 2.60
Inorganic Phosphate	1.29	0.8 - 1.5
Magnesium	0.84	0.7 - 1.10

1. What is the most critical result? (1 mark) 1 mark

2. List (2) possible cause of this result in this patient. (2 marks) 2 marks

3. List (3) expected ECG findings in this patient. (3 marks) 3 marks

4. State (4) treatments of the above critical result and their mechanisms of action. (8 marks) 8 marks

The admitting unit has asked you to establish goals of care for her admission.

5. State (4) factors that will influence your goals of care discussion. (4 marks) 4 marks

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