{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:35:22Z","timestamp":1756384522426,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,2,14]]},"abstract":"<jats:p>An altered mental status presents a diagnostic challenge for many clinicians. Described here is a case of primary hyperparathyroidism not initially suspected until after a thorough neurological and infectious cause were excluded. A 60-year-old woman presented with altered mental status and gait instability. Her family noticed progressive gait instability and mood swings for the past 4 months. Initial imaging and laboratory values were unable to explain her symptoms. On transfer out of the intensive care unit, her corrected calcium was found to be 13.3\u2009mg\/dL with an elevated parathyroid hormone. Her hypercalcaemia was refractory to medical management. Ultrasound found a 2 cm nodule, which was surgically removed and found to be a parathyroid adenoma. Her calcium normalised and neurological deficits subsided. Hypercalcaemia can lead to a constellation of symptoms that include the classical \u2018stones, bones, abdominal moans and psychic groans\u2019 and electrolyte derangements should be considered in the differential of altered mental status.<\/jats:p>","DOI":"10.1136\/bcr-2017-224089","type":"journal-article","created":{"date-parts":[[2018,3,5]],"date-time":"2018-03-05T09:15:43Z","timestamp":1520241343000},"page":"bcr-2017-224089","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["The forgotten electrolyte, when hypercalcaemia manifest as gait instability and altered mental status"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7941-3494","authenticated-orcid":false,"given":"Israel","family":"Ugalde","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Bello Segura","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University of Mississippi Medical Center, Jackson, Mississippi, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabrina","family":"Oneto","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari","family":"Ciment","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Mount Sinai Hospital, Miami Beach, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,5]]},"reference":[{"key":"2025082702214568000_2018.mar05_1.bcr-2017-224089.1","unstructured":"Shane E , Dinaz I . 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