A 67-Year-Old Man with a Advanced Multiple Myeloma Is Brought

A 67-year-old man with a advanced multiple myeloma is brought to the office due to progressively increasing generalized weakness and altered mental status for 5 days.  He currently takes acetaminophen, naproxen, and a fentanyl patch for pain.  Temperature is 36.5 C (97.7 F) , blood pressure is 120/70 mm Hg, and pulse is 68/min.  Examination shows no focal findings.  Laboratory results are as follows: Which of the following is the most likely explanation for this patient's altered mental status?

A) Accumulation of fentanyl
B) Hypercalcemia
C) Hyponatremia
D) Metastatic brain lesions
E) Uremia

Correct Answer:

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