A 71-year-old women with nausea, abdominal discomfort and reduced oral intake presents to her GP. Initial investigations reveal acute renal failure with hypercalcaemia. Her management is discussed.
Jane, aged 71 years, presents to you, her GP, with a three-month history of nausea, abdominal discomfort and reduced oral intake. She has had no vomiting or diarrhoea. Her family have noticed poor attention and concentration over the past few days. She has had associated weight loss of 5 kg over the past six weeks. Jane’s past medical history includes hypertension since the age of 65 years, treated with amlodipine, a minimal trauma fracture of the forearm one year previously and renal calculus five years previously. There is no significant family history.
On examination, Jane has a blood pressure of 120/70 mmHg, with a postural drop of 15 mmHg. Her heart rate is 85 beats per minute and in sinus rhythm. She has dry mucous membranes and reduced skin turgor. Findings of her cardiovascular and respiratory examinations are normal. An abdominal examination reveals generalised tenderness but no guarding or rigidity. There is no renal bruit and Jane has bilateral pitting oedema peripherally.
Initial investigations reveal acute renal failure with hypercalcaemia. The results of these investigations are shown in Table 1.