Reference no: EM133779173

Question

The following documentation is from the health record of a 40-year-old female patient. Emergency Department Services HPI: This is a 40-year-old female with a three-year history of diarrhea and a one-year history of epigastric discomfort. She had a CT scan with a mass on the tail of the pancreas, as well as gastrin level greater than 1,000 while taking Prilosec. She has been amenorrheic for the past four months. The patient presents to the emergency department with severe diarrhea and dehydration after discontinuing medications to allow for a repeat gastrin level off medications to eliminate the compounding effect of Prilosec on gastrin levels. Unfortunately, she was unable to stay off medication long enough, and she developed severe diarrhea with dehydration and a creatinine greater than 3, and she was admitted to observation services. Gastrin level is 1,023 with VIP of 290. Patient was rehydrated and orally treated with 200 mEq of potassium. The patient had significantly elevated calcium, which normalized with rehydration. Vitamin D level is pending, and PTH level also has returned elevated, concurrent with a calcium of 9.9. An MRI of the abdomen has revealed multiple lesions in the liver with a density consistent with metastatic malignancy. Additionally,