01-14-2010, 03:55 PM
A 48-year-old man is evaluated for weakness and fatigue. He has a history of hypertension and gout. Medications include ramipril, hydrochlorothiazide, and colchicine. Social history is significant for having lost his job 2 years ago, after which he has been drinking beer and wine every day. He does not have episodes of delirium tremens but admits to feeling guilty about his alcohol intake.
Physical examination reveals a disheveled man in no acute distress. The blood pressure is 135/80 mm Hg, and pulse rate is 78/min. Chvostek's sign is positive on the right. The liver is palpated 3 cm below the right costal margin and is tender to palpation. No spider angiomata or palmar erythema is noted.
Laboratory Studies
Hematocrit
33%
Sodium
133 meq/L (133 mmol/L)
Potassium
3.4 meq/L (3.4 mmol/L)
Blood urea nitrogen
25 mg/dL (8.93 mmol/L)
Creatinine
1.2 mg/dL (106.1 µmol/L)
Alanine aminotransferase
50 U/L
Aspartate aminotransferase
110 U/L
Alkaline phosphatase
55 U/L
Albumin
3.5 g/dL (35 g/L)
Calcium
7.2 mg/dL (1.8 mmol/L)
Which of the following is the most appropriate next test in the evaluation of this patient?
A Parathyroid hormone
B 25-hydroxyvitamin D
C 1,25 hydroxyvitamin D3
D Phosphate
E Magnesium
Physical examination reveals a disheveled man in no acute distress. The blood pressure is 135/80 mm Hg, and pulse rate is 78/min. Chvostek's sign is positive on the right. The liver is palpated 3 cm below the right costal margin and is tender to palpation. No spider angiomata or palmar erythema is noted.
Laboratory Studies
Hematocrit
33%
Sodium
133 meq/L (133 mmol/L)
Potassium
3.4 meq/L (3.4 mmol/L)
Blood urea nitrogen
25 mg/dL (8.93 mmol/L)
Creatinine
1.2 mg/dL (106.1 µmol/L)
Alanine aminotransferase
50 U/L
Aspartate aminotransferase
110 U/L
Alkaline phosphatase
55 U/L
Albumin
3.5 g/dL (35 g/L)
Calcium
7.2 mg/dL (1.8 mmol/L)
Which of the following is the most appropriate next test in the evaluation of this patient?
A Parathyroid hormone
B 25-hydroxyvitamin D
C 1,25 hydroxyvitamin D3
D Phosphate
E Magnesium