Question of the Week # 445

Posted on June 9, 2013 by Archer USMLE Reviews

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

Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER FLUID AND ELECTROLYTES, ARCHER GENERAL MEDICINE, ARCHER NEPHROLOGY, dr.red nephrology lecture, internal medicine board review, usmle step 3 nephrology |

19 Responses

manuelchiky, on June 9, 2013 at 2:39 am said:

D

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TARA, on June 9, 2013 at 2:54 am said:

D) Promoting loop diuresis to remove the hypercalcemia, along with intensive hydration

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Sanghee, on June 9, 2013 at 7:30 am said:

D

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Dr. Arabi, on June 9, 2013 at 8:10 am said:

E

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Dr. Arabi, on June 9, 2013 at 8:19 am said:

E.
not “D” for 2 reasons:
1) BP is low (90/60) thus you can put the pt. is shock if try to dehydrate him although you are trying to help excrete Calcium.
2) Calcium level is too high and had already caused the pt. to be in AMS, thus the best and fastest way to rid of Calcium after hydration is to dialyze Calcium out.

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Alan, on June 9, 2013 at 11:30 am said:

D

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rafiq78, on June 9, 2013 at 1:07 pm said:

D

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Roy, on June 9, 2013 at 1:51 pm said:

Hydration and diuretic is ok

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toufan, on June 15, 2013 at 5:28 pm said:

D loop diuretics!

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Bj, on June 15, 2013 at 10:33 pm said:

D

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ANU, on June 20, 2013 at 1:29 pm said:

looking like SARCOIDOSIS

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Gity, on June 27, 2013 at 4:39 am said:

D because the problem has renal failure and sever hyperglycemia. Needs dialysis

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David, on July 16, 2013 at 11:23 pm said:

Dr. what is the ans???

thanks

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shantiram, on August 17, 2013 at 3:02 am said:

d is the ans

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vij4744, on August 21, 2013 at 7:03 pm said:

E is the answer. Regular approach to hypercalcemia is definitely through loop diuretics. But this patient is with renal failure. So it’s dialysis that can save him.

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ria, on October 21, 2013 at 11:12 pm said:

Hemodialysis or peritoneal dialysis with low calcium levels in the dialysis fluid is effective for removing calcium from the circulation. These methods are used for patients with renal insufficiency and congestive heart failure when saline infusion is not feasible

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Swati, on October 29, 2013 at 4:50 pm said:

How do i get to know weather my answer is right or wrong?Is there any representative of Archers who is posting the correct answer?

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seb, on August 2, 2015 at 1:01 pm said:

lab values for renal failure??

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seb, on October 28, 2015 at 6:59 pm said:

this patient probably has Sarcoid disease and has developed hypercalcaemia, causing AMS, based on the lab values this patient has also developed ARF, therefore loop diuresis is pretty redundant here, and thus requires hemo or peritoneal dialysis to remove the calcium from the circulation, it would be acceptable? if there was mild renal insufficiency for loop diuresis as you agressively hydrate for hypercalcaemia but you have to be careful not to put the patient into shock, over diuresis also can cause severe renal insufficiency.

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