Question of the Week # 89

A 61-year-old man is admitted because of altered mental status. On physical examination, he is afebrile. Laboratory studies show sodium 136 mmol/L, potassium 4.4 mmol/L, chloride 108 mmol/L, CO2 30 mmol/L, glucose 78 mg/dL, urea nitrogen 49 mg/dL, calcium 13.8gm%, creatinine 5 mg/dL, hemoglobin 8.9gm%, total protein 8.3 g/dL, albumin 3.7 g/dL, alkaline phosphatase 116 U/L, AST 45 U/L, ALT 22 U/L, and total bilirubin 1.2 mg/dL.  The patient is started on aggressive Intravenos hydration. Which of the following may be typically seen with this patient’s disease?

A) Hypercellular Bone marrow with many blasts

B) Serum protein electrophoresis with polyclonal hypergammaglobulinemia

C) An increase in all immunoglobulins ( IgA, IgG and IgM)

D) A negative anion gap

E) Increased Alkaline Phosphatase

F) A positive bonescan

4 Responses

  1. answer: B

    • AA

  2. B

  3. A: Is the answer.
    Dx is MM. not B b/c the SERUM protein electrophoresis is monoclonal (IgG) not polyclonal
    ( URINE protein electrophoresis detects Bence-Jones proteins).

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