28239141 Visualization

A 58 Age - year Age - old Age white Personal_background American Personal_background male Sex presented Clinical_event to the emergency Nonbiological_location department Nonbiological_location ( ED Nonbiological_location ) with acute Detailed_description onset Detailed_description of confusion Sign_symptom , disorientation Sign_symptom , inability Sign_symptom to Sign_symptom walk Sign_symptom steadily Sign_symptom , and dehydration Sign_symptom with associated generalized weakness Sign_symptom , polyuria Sign_symptom , and polydipsia Sign_symptom over Duration the Duration previous Duration week Duration .
He had been diagnosed Clinical_event with CML Disease_disorder six Date years Date earlier Date , with no hematological Sign_symptom response Sign_symptom to multiple Detailed_description chemotherapy Medication regimens Detailed_description ; he was at that time on treatment with allopurinol Medication and awaiting Clinical_event allogenic Detailed_description bone Therapeutic_procedure marrow Therapeutic_procedure transplant Therapeutic_procedure .
Vital Diagnostic_procedure signs Diagnostic_procedure on admission Clinical_event to the ED Nonbiological_location included heart Diagnostic_procedure rate Diagnostic_procedure of 104 Lab_value bpm Lab_value , blood Diagnostic_procedure pressure Diagnostic_procedure of 122/68 Lab_value mm Lab_value Hg Lab_value and temperature Diagnostic_procedure of 99.7°F Lab_value ( 37.6°C Lab_value ).
There were no Lab_value remarkable Lab_value findings Lab_value on physical Diagnostic_procedure examination Diagnostic_procedure except for altered Sign_symptom mental Sign_symptom status Sign_symptom and dehydration Sign_symptom .
Laboratory Diagnostic_procedure evaluations Diagnostic_procedure were: hemoglobin Diagnostic_procedure 13.3 Lab_value g/dL Lab_value , white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure 18.3×109/L Lab_value ( neutrophils Lab_value 79.6% Lab_value , lymphocytes Lab_value 7.2% Lab_value , and monocytes Lab_value 8.3% Lab_value ), and platelet Diagnostic_procedure count Diagnostic_procedure 910×109/L.
Serum Diagnostic_procedure levels Diagnostic_procedure were: calcium Diagnostic_procedure 18.6 Lab_value mg/dL Lab_value , phosphate Diagnostic_procedure 4.6 Lab_value mg/dL Lab_value , sodium Diagnostic_procedure 135 Lab_value mEq/L Lab_value , potassium Diagnostic_procedure 2.7 Lab_value mg/dL Lab_value , albumin Diagnostic_procedure 4.0 Lab_value g/dL Lab_value , creatinine Diagnostic_procedure 2.2 Lab_value mg/dL Lab_value , total Diagnostic_procedure bilirubin Diagnostic_procedure 0.9 Lab_value mg/dL Lab_value , alkaline Diagnostic_procedure phosphatase Diagnostic_procedure 125 Lab_value IU/L Lab_value , aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure 41 Lab_value IU/L Lab_value , and alanine Diagnostic_procedure aminotransferase Diagnostic_procedure 71 Lab_value IU/L.
SPEP Diagnostic_procedure was negative Lab_value for Lab_value an Lab_value M Lab_value spike Lab_value .
Hormones Diagnostic_procedure and Diagnostic_procedure vitamins Diagnostic_procedure levels Diagnostic_procedure were: PTH Diagnostic_procedure 8.5 Lab_value pg/L Lab_value (15–65 pg/L), PHTrP Diagnostic_procedure 1.4 Lab_value pg/L Lab_value (<2 pg/L), 25 Diagnostic_procedure - OH Diagnostic_procedure vitamin Diagnostic_procedure D Diagnostic_procedure 30.4 Lab_value ng/mL Lab_value (20–50 ng/mL) and 1,25 Diagnostic_procedure OH Diagnostic_procedure vitamin Diagnostic_procedure D3 Diagnostic_procedure 33.7 Lab_value ng/mL Lab_value (18–64) ng/mL.
Chest Biological_structure CT Diagnostic_procedure scan Diagnostic_procedure showed diffuse Detailed_description lytic Detailed_description lesions Sign_symptom and bone Sign_symptom destruction Sign_symptom throughout the visualized thoracic Biological_structure skeleton Biological_structure , concerning for diffuse bone Sign_symptom marrow Sign_symptom involvement Sign_symptom .
The clinical history and biochemical findings led to a diagnosis Clinical_event of CML Disease_disorder -associated hypercalcemia Sign_symptom in the context of a blast Sign_symptom phase Sign_symptom .
Treatment with aggressive Detailed_description hydration Therapeutic_procedure with 0.9% Lab_value saline Medication and calcitonin Medication 400 Dosage units Dosage subcutaneous Administration was administered.
Additionally, zoledronic Medication acid Medication 3.3 Dosage mg Dosage intravenous Administration , adjusted Detailed_description for Detailed_description renal Detailed_description insufficiency Detailed_description , was given.
After Duration five Duration days Duration of treatment, normalization Lab_value of symptoms Sign_symptom and serum Diagnostic_procedure calcium Diagnostic_procedure levels Diagnostic_procedure were achieved.
After discharge Clinical_event from the hospital Nonbiological_location , the patient continued with palliative Therapeutic_procedure treatment Therapeutic_procedure with ponatinib Medication and radiotherapy Therapeutic_procedure .
Acceptable serum Diagnostic_procedure calcium Diagnostic_procedure levels Diagnostic_procedure were maintained Lab_value with zoledronic Medication acid Medication 4 Dosage mg Dosage every Dosage eight Dosage weeks Dosage .
Despite these therapies, his cancer Disease_disorder progressed and he passed Outcome away Outcome approximately eight Date months Date after Date the initial admission for hypercalcemia.