A middle aged man with history of hypertension and GORD, presented to the emergency department with epigastric pain. He looked slightly dehydrated.
Venous blood gas showed the following:

PH = 7.49

PCO2 = 50 mmHg

PO2 = 42 mmHg

HCO3 = 41 mmol/L

Na = 144 mmol/L

Cl = 94 mmol/L

K = 3.5 mmol/L

Calcium (Ionised) = 1.63 mmol/L (Normal range= 1.12 – 1.32).

Glucose = 5.6 mmol/L

Lactate = 2.1 mmol/L

Creatinine = 168 umol/L

Questions:

• Interpret these blood gases and what are the causes of these changes?
• What is the Differential diagnosis of hypercalcemia and what additional tests are required?
•  What is your management approach for hypercalcemia?