A 60-year-old woman complains of muscle weakness, constipation, nausea, and frequent urination, and is displaying bizarre behavior. The woman takes prescribed thiazide diuretics
What statement made by the patient might be an additional cause of her symptoms?
a. "I have been working hard to drink plenty of water to prevent dehydration."
b. "I should probably tell you I take steroids regularly because of my asthma."
c. "I take calcium supplements to prevent osteoporosis and eat lots of dairy foods."
d. "I recently quit drinking alcohol. I quit cold turkey and did it all by myself."
C
The patient is exhibiting symptoms of hypercalcemia. Thiazide diuretics can cause elevated calcium levels in the blood by decreasing the amount of calcium excreted in the urine. Excessive intake of calcium would add to his effect, helping to explain how the symptoms have occurred. Drinking too much water would explain hyponatremia, not hypercalcemia; also, she did not say how much water she drank. Steroids would explain hypokalemia, but not hypercalcemia. Alcohol withdrawal would explain hypophosphatemia, but not hypercalcemia.
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