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CASE REPORT
The forgotten electrolyte, when hypercalcaemia manifest as gait instability and altered mental status
  1. Israel Ugalde1,
  2. Manuel Bello Segura2,
  3. Sabrina Oneto3,
  4. Ari Ciment4
  1. 1 Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
  2. 2 Department of Endocrinology, University of Mississippi Medical Center, Jackson, Mississippi, USA
  3. 3 Department of Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA
  4. 4 Department of Pulmonary, Mount Sinai Hospital, Miami Beach, Florida, USA
  1. Correspondence to Dr Israel Ugalde, israel.ugalde{at}msmc.com

Summary

An altered mental status presents a diagnostic challenge for many clinicians. Described here is a case of primary hyperparathyroidism not initially suspected until after a thorough neurological and infectious cause were excluded. A 60-year-old woman presented with altered mental status and gait instability. Her family noticed progressive gait instability and mood swings for the past 4 months. Initial imaging and laboratory values were unable to explain her symptoms. On transfer out of the intensive care unit, her corrected calcium was found to be 13.3 mg/dL with an elevated parathyroid hormone. Her hypercalcaemia was refractory to medical management. Ultrasound found a 2 cm nodule, which was surgically removed and found to be a parathyroid adenoma. Her calcium normalised and neurological deficits subsided. Hypercalcaemia can lead to a constellation of symptoms that include the classical ‘stones, bones, abdominal moans and psychic groans’ and electrolyte derangements should be considered in the differential of altered mental status.

  • primary care
  • calcium and bone
  • general practice / family medicine
  • psychiatry
  • neurology
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Footnotes

  • Contributors All authors have directly participated in the planning and execution of this case report in medicine. IU and MBS were the internal medicine physicians responsible for the care of the patient during the hospitalisation in advisement with AC as the intensive care physician. SO was the pathologist who contributed to the diagnosis of parathyroid adenoma. All authors contributed to the content and revision of the final manuscript. Figures and tables were created by IU and he was responsible for explaining the consent to publish to the patient during her hospitalisation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None delcared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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