Hypercalcemia. Malignancy. Bad News.

A 63-year-old male with stage 4 metastatic small cell lung cancer, presents to the ED with his wife. He is confused, and his wife says that he has been nauseous, constipated, and increasingly fatigued over the past week.

He was first diagnosed with lung cancer 5 years ago and was in remission until recently when he was recently diagnosed with recurrent disease. He is not currently on treatment but has an upcoming appointment with oncology.

Goals and Objectives

Educational Goal:

• To seek out goals of care information in an oncology patient, and to treat acute complications of malignancy accordingly.

CRM Objectives:

• Compassionately discuss bad news with patient’s family, recognizing the limitations of prognostication within the ED.
• Initiate goals of care discussion with substitute decision maker to determine appropriate disposition.

Medical objectives:

• Order appropriate labs and diagnostic imaging workup for an elderly oncology patient presenting with confusion.
• Recognize the signs and symptoms of hypercalcemia in an oncology patient.
• Initiate emergency medical treatment for hypercalcemia of malignancy.