Case 29: Introduction

History of Present Illness (HPI)

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A 64 year-old man with a past medical history of hypertension, depression, and IgG lambda multiple myeloma presents to the hospital to initiate chemotherapy.

He reports fatigue and night sweats. His multiple myeloma was diagnosed recently in the setting of weight loss and bone pains. He does not have shortness of breath, leg swelling, syncope, light-headedness, dizziness, nausea, vomiting, abdominal pain, diarrhea, or constipation. He reports he has been urinating normally. His appetite has been fair, he reports intake of both solids and liquids. On further review of systems, he says he has not had vision changes, headache, confusion, or changes in mood. His wife reports he has been his “usual self.”

His medications include amlodipine and fluoxetine. He has not received prior chemotherapy and he has no surgical history. He does not use tobacco, alcohol, or illicit drug use.

Before initiating his chemotherapy treatment, his provider checks basic labs.
Basic chemistry panel

Based on these findings, you are consulted for his hyponatremia.

Click here for the physical exam!

Basic Lab Ref