“Blood in My Urine” continued


  • Urology consulted, performed ureteroscopic stone fragmentation and removal the following day


  • Treated with IV fluids, Zoledronic Acid, and Calcitonin -> serum calcium normlized within 2 days
  • Hydrochlorothiazide was discontinued
  • PTH resulted low at 8 pg/mL
  • 25-OH-Vitamin D and 1,25-OH-Vitamin D levels were within normal limits
  • PTHrP ordered, returned a few days later elevated at 7.2 pmol/L
  • CT chest with contrast demonstrated a large left hilar mass
  • EBUS (Endobronchial ultrasound) with biopsy revealed squamous cell carcinoma, PD-L1 negative
  • PET/CT showed likely metastases in the liver
  • Palliative Care was consulted (see the evidence)
  • The patient was initiated on combination chemotherapy with carboplatin and paclitaxel

For more information, see Hypercalcemia


  1. Temel, J., Al., E., Hospital, A., Meier, A., K. G. Blumenthal and Others, & Others, N. (2010, August 19). Early palliative care for patients with metastatic Non–Small-Cell lung CANCER: NEJM. Retrieved March 12, 2021, from https://www.nejm.org/doi/full/10.1056/NEJMoa1000678

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