Correct!
5. All of the above
The abdominal x-ray shows a large amount of stool in the retrosigmoid region with a moderate amount of stool in the right colon and gaseous distention of the transverse colon. This combined with her complaints and physical findings suggests intestinal obstruction or psudeo-obstruction. The later occurs when findings are suggestive of obstruction in the absence of any demonstrable mechanical obstruction and is also known as Ogilvie Syndrome. All of the listed causes may cause intestinal pseudo-obstruction although a transient postoperative ileus is the most common cause (1).
Certainly drug abuse with sharing of needles has been a common cause of HIV+ and AIDS. Anticholinergic abuse might also case pseudo-obstruction although usually not in this clinical situation.
Laboratory evaluation was performed to examine for electrolyte disturbances and the serum calcium was found to be markedly elevated at 15.1 mg/dL (normal 8.6-10.4 mg/dL).
The mechanism of how hypercalcemia causes significant constipation is not well understood, but may be related to decreased intestinal smooth muscle tone and associated with abnormal autonomic nerve function (2).
Which of the following laboratory tests should be ordered to determine the cause of her hypercalcemia? (Click on the correct answer to proceed to the third of six panels)