75yo John presents to the hospital with a lower respiratory tract infection. His blood test show eGFR is 40 and creatinine >100. His previous blood test earlier in the year eGFR 79 and creatinine 65. You diagnose him with acute kidney injury.

The diagnosis of hypercalcemia most often is made incidentally when a high calcium level is detected in blood samples. The principal challenges in the management of hypercalcemia are distinguishing primary hyperparathyroidism from conditions that will not respond to parathyroidectomy and knowing when it is appropriate to refer the patient for surgery.