Endgames Case Report

A case of profound hypercalcaemia and acute kidney injury

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6744 (Published 18 November 2013) Cite this as: BMJ 2013;347:f6744
  1. Haseeb Rahman, core medical trainee1,
  2. Peter Dupont, consultant nephrologist2,
  3. Mark Cohen, consultant endocrinologist1,
  4. Rama Vancheeswaran, consultant in respiratory medicine1
  1. 1Barnet General Hospital, London EN5 3DJ, UK
  2. 2Royal Free Hospital, London, UK
  1. Correspondence to: haseebrahman1{at}gmail.com

A 58 year old white man presented with a three month history of malaise, poor appetite, aching joints, and constipation. He also reported long standing dyspepsia and often self medicated with antacid tablets bought over the counter. In addition, he described having lower urinary tract symptoms of hesitancy and urgency.

His medical history showed that he had been diagnosed with hypertension some years previously and was receiving treatment with a thiazide diuretic (bendroflumethiazide). He had a 20 pack year smoking history and was unemployed.

On examination, his pulse was 100 beats/min, blood pressure was 121/75 mm Hg, and he had a low grade fever. He had dry mucous membranes and was mildly disoriented. Cardiovascular examination was normal. Some mild epigastric tenderness was elicited on deep palpation of the abdomen. Neurological examination was normal.

The box shows his initial blood test results. Chest radiography was unremarkable. Dipstick urinalysis showed blood +3 and protein +2. Venous blood testing showed pH 7.45, lactate 1.4 mmol/L (1 mmol/L=9.01 mg/dL), and bicarbonate 23 mmol/L. A renal tract ultrasound scan showed preserved renal size and no evidence of obstruction.

Initial blood test results (reference values in parenthesis)

  • Haemoglobin 143 g/L (130-180), white blood cell count 14.4×109/L (3.5-11), platelets 147×109/L (130-450), sodium 135 mmol/L (136-145), potassium 5.3 mmol/L (3.5-5.1), urea 33.1 mmol/L (3.0-9.2; 1 mmol/L=2.8 mg/dL), creatinine 527 µmol/L (64-111; this value had been 84 µmol/L two months earlier; 1 µmol/L=0.01 mg/dL); erythrocyte sedimentation rate 159 mm in the first hour (<3)

  • Serum calcium (corrected) 5.06 mmol/L (2.15-2.61), serum calcium (total) 5.02 mmol/L (2.15-2.61; 1 mmol/L=4 mg/dL), phosphorus (inorganic) 1.59 mmol/L (0.74-1.52; 1 mmol/L=3.10 mg/dL), alkaline phosphatase 128 U/L (40-150; 1 U/L=0.02 µkat/L)

  • Alanine aminotransferase 28 U/L (<55; 1 U/L=0.02 µkat/L), bilirubin 15 μmol/L (3-21; 1 μmol/L=0.06 mg/dL), albumin 31 g/L (35-50), total protein 81 g/L (64-83), total globulin 50 g/L …

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