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A 16-Year-Old Boy Is Evaluated by the Medical Team in the Intensive

question 284

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A 16-year-old boy is evaluated by the medical team in the intensive care unit. He was admitted 3 weeks ago following a motor vehicle accident. The patient sustained a C5-C6 fracture with dislocation, which resulted in quadriplegia. He currently has a tracheostomy tube and requires mechanical ventilation, and is being fed by a percutaneous endoscopic gastrostomy tube. A week ago, the patient was diagnosed with ventilator-associated pneumonia, which is being treated with piperacillin-tazobactam. His mother says that before his injury he was trying to "build up his muscles" by drinking protein shakes and taking creatine supplements. Medical history is otherwise unremarkable. The patient's mother has Graves disease and his father has hypertension. He has no siblings. Blood pressure is 124/70 mm Hg and pulse is 64/min. Coarse crackles are heard at the right lung base. Laboratory results are as follows: $A 16-year-old boy is evaluated by the medical team in the intensive care unit. He was admitted 3 weeks ago following a motor vehicle accident. The patient sustained a C5-C6 fracture with dislocation, which resulted in quadriplegia. He currently has a tracheostomy tube and requires mechanical ventilation, and is being fed by a percutaneous endoscopic gastrostomy tube. A week ago, the patient was diagnosed with ventilator-associated pneumonia, which is being treated with piperacillin-tazobactam. His mother says that before his injury he was trying to build up his muscles by drinking protein shakes and taking creatine supplements. Medical history is otherwise unremarkable. The patient's mother has Graves disease and his father has hypertension. He has no siblings. Blood pressure is 124/70 mm Hg and pulse is 64/min. Coarse crackles are heard at the right lung base. Laboratory results are as follows: Repeat testing confirms these values. Ionized calcium level is 6.6 mg/dL (normal: 4-5.6 mg/dL) . Which of the following is the most likely cause of this patient's hypercalcemia? A) Enteral nutrition B) Granulomatous lung infection C) Hyperthyroidism D) Immobilization E) Paraproteinemia$ Repeat testing confirms these values. Ionized calcium level is 6.6 mg/dL (normal: 4-5.6 mg/dL) . Which of the following is the most likely cause of this patient's hypercalcemia?

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