Abstract: SA-PO995

Watch What You Eat: An Unusual Cause of Hypercalcemia

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Leghrouz, Muhannad, University of Florida, Gainesville, Florida, United States
  • Koratala, Abhilash, University of Florida, Gainesville, Florida, United States
  • Tantravahi, Jogiraju V., University of Florida, Gainesville, Florida, United States
Background

Primary hyperparathyroidism and malignancy are by far the most common causes of hypercalcemia, though the differential diagnosis is usually broad. Determining the etiology of hypercalcemia is the cornerstone of its management. Herein, we describe an interesting case of a patient who developed severe hypercalcemia as a result of “pica”, which in turn was secondary to iron deficiency anemia.

Methods

A 66-year-old man with history of hypertension and diabetes mellitus type 2 has presented with fatigue, diarrhea, polyuria and hand tremors for 3 days. His vitals were stable. Laboratory values demonstrated acute kidney injury with a serum creatinine of 2.2 mg/dL (baseline ~1), hypercalcemia with serum calcium 14.8 mg/dL, and metabolic alkalosis with a bicarbonate level of 39 mmol/L. His hemoglobin was 10.7 g/dL. Patient denied taking any antacids, calcium or vitamin D supplements. His serum PTH was 15 pg/mL, PTH-related peptide and vitamin D level were not elevated. Protein electrophoresis was negative for paraproteinemia and age-appropriate cancer screening was apparently negative. He was found to be iron deficient with an iron saturation of 6% and on detailed questioning, he admitted to having an irresistible urge to eat small white stones from his backyard, which are found to be chalks, i.e., calcium carbonate [Figure 1]. This is the most likely cause for both his hypercalcemia and metabolic alkalosis. The patient was managed with counselling and further work up for his iron deficiency has been negative so far.

Conclusion

Pica is characterized by an appetite for substances that are largely non-nutritive, such as ice, paper, metal, paint, stones etc. It has been linked to iron deficiency and mental disorders of obsessive–compulsive spectrum. In our patient, pica has turned out to be the cause for hypercalcemia. Through this case report, we would like to emphasize the importance of “most inexpensive” investigation in the evaluation of hypercalcemia, i.e., “careful history taking".