445) A 45 year old african-american man presents to the emergency room with altered mental status. His past medical history is significant for skin nodules. One of the nodule was recently biopsied and it revealed non-caseating granuloma. On examination, his oral mucosae are dry. Blood pressure is 90/60 . Skin examination reveals multiple scattered skin nodules about 1 to 2cm in diameter. Chest X-ray reveals bilateral hilar adenopathy. Laboratory Studies reveal
WBC 5400/µl
HGB: 11.8 gm%,
Platelets : 300k/µl
Calcium 14.2gm%
Creatinine 3.2mg%
Phosphorous 2.2mg%
He is started on agressive intravenous hydration. In addition to the above measures, you should also proceed with intervention directed to towards which of the following at this time ?
A) Reducing serum phosphorous
B) Reducing serum parathyroid hormone
C) Reducing Blood Calcitrol level
D) Promoting loop diuresis
E) Direct removal of calcium by Hemodialysis
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