Electrolyte Case 7 A 66-year-old man had fallen out of a tree 4 years previously
ID: 126456 • Letter: E
Question
Electrolyte Case 7
A 66-year-old man had fallen out of a tree 4 years previously without any apparent fractures. Since that time he has complained of pain over the ribs. The patient had a firm marble-sized mass in his neck for the past 10-15 years. The size has remained constant until the last 6 months. At that point the mass was enlarged. A chest X-Ray revealed multiple rib fractures.
Laboratory Data:
Patient Results
Reference Range
Na
120
136-145 mEq/L
K
4.0
3.5-4.5 mEq/L
Cl
100
98-107 mEq/L
CO2
24
23-29 mEq/L
Glucose
95
74-100 mg/dL
BUN
15
6-20 mg/dL
Creat
0.8
0.9-1.3 mg/dL
TP
13.2
6.4-8.3 g/dL
Albumin
4.0
3.2-4.6 g/dL
Osmo
290
275-299 mOsm/kg
U Osmo
440
50-1400 mOsm/kg
Additional tests revealed a normal Renin, Aldosterone, and ADH.
Determine the condition that would manifest these symptoms and test results
Patient Results
Reference Range
Na
120
136-145 mEq/L
K
4.0
3.5-4.5 mEq/L
Cl
100
98-107 mEq/L
CO2
24
23-29 mEq/L
Glucose
95
74-100 mg/dL
BUN
15
6-20 mg/dL
Creat
0.8
0.9-1.3 mg/dL
TP
13.2
6.4-8.3 g/dL
Albumin
4.0
3.2-4.6 g/dL
Osmo
290
275-299 mOsm/kg
U Osmo
440
50-1400 mOsm/kg
Explanation / Answer
Since the patient has AG reversal high protein and multiple fracture could be secondary to bone weakening and keeping age in the picture the likely diagnosis of the patient could be multiple myeloma. A serum electrophoresis and serum free light chain assay can help in diagnosing the problem.
The mass present could be plasmacytoma or an enlarged lymph node. A biopsy or an FNAC can help in confirming the diagnosis.
The low sodium could be the paraneoplastic syndrome.
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