Question of the Week # 330

330) A 55 year old man is brought by the EMS to the emergency room in a disoriented state. The patient has alcohol smell on his breath. Reviews of his past records reveal history of chronic alcohol abuse. His girlfriend arrives in the ER few minutes later and she reports that the patient has not been eating anything because he has been drinking heavily and vomiting over the past three days. On examination, he is afebrile, blood pressure 130/82 mm Hg, RR 18/min and Pulse 82/min. When the nurse attempts to check blood pressure, the patient develops carpo-pedal spasm (Trousseau sign). Chest is clear to auscultation.

Laboratory investigations reveal:

Ethanol level 140mg%

Serum Sodium 142 meq/L

Serum Potassium 3.2meq/L

Serum Chloride 106meq/L

Calcium 6.2 mg% (N = 9.0 to 10.5)

Bicarbonate 25 meq/L

Creatinine 1.2 mg%

Albumin 3.9 gm% (N = 3.5 to 5.0 gm %)

Patient is treated with Calcium gluconate and then, another dose of calcium chloride. Repeat serum calcium level is 5.8mg%. Trousseau sign is still positive.

Which of the following is the most appropriate next step in managing this patient?

A) Obtain Serum Ionized Calcium

B) Obtain Serum Magnesium Level

C) Obtain Paratharmone level

D) Start potassium chloride

E) Obtain Vitamin D level

10 Responses

  1. bbbbbbbbbbbbbbb

  2. b

  3. Hpocacimia and hypmagnesimia may in someway related and parathyroid glands may also be involved ,so I guess the Answer is B. Otbtain serum magnesium level.

  4. B) Obtain Serum Magnesium Level

  5. b

  6. bbb

  7. b

  8. I THINK IT’S “B”

  9. Mg levels r always important to measure.

  10. B
    Hypomagnesemia and severe hypermagnesemia, both can produce hycalcemia by dierents mechanisms. Both decrease entry of calcium Into the circulation

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