A 58-Year-Old Man Comes to the Office Due to Fatigue

A 58-year-old man comes to the office due to fatigue, decreased appetite, muscle cramps, and nausea.  The patient has chronic kidney disease resulting from primary focal segmental glomerulosclerosis.  His current medications include a vitamin D supplement.  While his blood pressure is being obtained, the patient develops carpal spasm.  Bilateral lower extremity pedal edema is noted.  Laboratory evaluation shows a blood urea nitrogen level of 120 mg/dL, serum creatinine level of 10 mg/dL, and serum calcium level of 6 mg/dL.  Which of the following is most likely contributing to this patient's carpal spasm?

A) Hyperphosphatemia
B) Hypoparathyroidism
C) Low albumin level
D) Low fibroblast growth factor 23 level
E) Vitamin D toxicity

Correct Answer:

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