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Background
Known previous TB + Thoracoplasty 1958
Gallstones removed via ERCP 2012
Bipolar affective disorder and depression >40yrs. On lithium therapy (600mg OD 2013) since at least 2005 with serum levels stable.
Long standing normocytic anaemia (stable Hb at ~125)
Other meds:
Olanzapine
Mirtazapine
Zopiclone
Other admission bloods:
CR 502, UR 31, Na/K normal
aCa 4.11, PO4 1.90, ALP 134
PTH <0.3, Vit D 22, ACE 36.2 (15-70)
FBC - Hb 111, WBC 11.1, MCV 92.7
LFT - NAD
Electrophoresis/BJP - NAD but raised beta 2 microglobulin (?secondary to RF)
Lithium 0.63.
PTHrP - Undetectable
Other investigations
XR/CT chest - abnormalities but confirmed by Resp team opinion was changes were earlier secondary to TB/thoracplasty and not any recent changes.
No evidence of active TB or sarcoid
Skeletal survey and all other MRI/CT - NAD
Patient denies any OTC meds or remedies
Treatment
Rehydrated, lithium stopped - Ca down to 2.65 two weeks later
Calcium then inexplicably rises again to 3.6
He's given 30mg pamidronate (2 doses) and a few days later cinacalcet (single dose) which causes calcium to drop to 2.05 over the course of 1 week.
His vit D is then normalised with 50,000U bolus of cholecalciferol and his calcium stablises at around 2.40 with CR 110. Patient discharged 3 days later.
Questions
Stuart
Stuart Jones |
Principal clinical biochemist
Clinical biochemistry / Pre-natal screening
King George Hospital
Barking, Havering and Redbridge University Hospitals NHS Trust
Technical lead | Lab Tests Online UK
http://www.labtestsonline.org.uk/
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