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1、以下讨论的是一个癌症病人化疗之后的相关症状，不能仅仅用化疗药物的副作用来敷衍了事，草草处理病人化疗之后的不适，本例中的病人，其原因为高钙血症，本幻灯片提出了高钙血症的相关鉴别诊断和处理PresentillnessThis65y/omalepatientwasdiagnosedlungcancerstageIVwithbonemetaS/PpostC/T.Hehadreceived3-3coursechemotherapywithGemzarwithCisplatin28dayscycle.Hew
2、asreferredtoourhospitalandhadreceivedchemotherapywithTaxotere28dayscyclingsince90-05-23.Hefeltnauseaandgeneralmalaiseduringthiscourseofchemotherapy.Weakness,fever,chillnessfordays&falldownyesterday.Bil.hand&L'tkneeabrasionw'dwasnote.Thistime,heisadmi
3、ttedforanothercoursechemotherapy.PasthistorydeniedDM,HTNPersonalhistory1.Smoking(+),2PPD/dayfor40+years 2.Alcoholdrinking(+) 3.Medication:denied 4.Allergyhistory:deniedPhysicalexaminationGeneralappearance:weakness(+)Cons:clear,E4V5M6Vitalsign:TPR:37.
4、6/100/20BP:124/81mmHgHEENT:Conj:injectedSclera:anictericNeck:supple,noLAP,noJVEThyroid:N.P.Axillary:noLAPChest:symmetricexpansionbreathingsound:R'tcoarseHeart:RHBwithoutmurmur,tachycardiaAbd:softandflat,notenderness,noreboundingpainHypoactivebowelsou
5、nd,Liver/spleen:impalpable,nopalpablemassExt:freelymovable,nopittingedemaLaboratoryWBC:17000Hb:10.0Plt:420Kn-seg76.2%lymph16.2%mono7.4%eosin0%baso0.2%GOT:52GPT67BUN:20.3Cr:0.7Na:127K:4.1Ca:8.6Impression1.pneumonia,RLL2.lungcancerwithbonemetastasis,st
6、ageIVs/pCT3.suspectedSIADHHosptialcourse8/31urineculture:Cadidaalbicans9/6leftlegedema+++,R/ODVT9/8sputumcluture:Ecoli9/9Fragmin1/2ampx3days+lasix1#qd9/12doppermoderateDVToverleftlowerlimb9/21Ca:12.7Lasix+5%GS1000ml9/24Aredia4mp9/25Aredia4amp9/27Ca:1
7、0.2DiscussionHypercalcemiaClinicalmaifestations:Renalmanifestation:polyuria,nephrolithiasisGIsymptoms:anorexia,nausea,vomiting,andconstipationNeurologicfinding:weakness,fatigue,confusion,stuporandcomaEKGmanifestation:shortenedQTintervalI.Parathyoid-r
8、elatedA.primaryhyperparathyroidism 1.solitaryadenomas 2.multipleendocrineneoplasia B.lithiumtherapy C.familialhypocalcurichypercalcemiaII.Malignancy-relatedA.solidtumorwithmetastases(breast) B.solidtumorwithhumoralmediationofhypercalcemia(lung,kidney
