Dr. Roach: Sixty-five-year old gets hospitalized due to hypercalcemia

Key Points:

• A 65-year-old patient experienced severe hypercalcemia (calcium level 14 mg/dL) with no identified cause despite extensive testing; Dr. Roach suggests pseudohypercalcemia as a possible explanation due to abnormal protein binding or blood draw technique.
• Primary hyperparathyroidism, caused by a benign tumor on the parathyroid glands, is the most common cause of high calcium and should have been tested initially; serious causes are unlikely given the patient's current health.
• Pseudohypercalcemia can result from prolonged tourniquet use during blood draw, causing falsely elevated calcium levels, which can be confirmed by measuring ionized calcium.
• For a patient with Pseudomonas aeruginosa in urine, ciprofloxacin is the only reliable oral antibiotic despite its risks, including hallucinations, tendon rupture, and possible aortic aneurysm; intravenous antibiotics are the alternative.
• Treatment should only proceed if there are symptoms indicating true infection rather than colonization, and patients should discuss concerns and alternatives with their doctors before starting risky antibiotics.