“Blood in My Urine” continued

Nephrolithiasis

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

Hypercalcemia

  • 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

Resources

  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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