A 55-Year-Old Man Whith a History of Chronic Kidney Disease

A 55-year-old man whith a history of chronic kidney disease comes to the physician due to progressive fatigue, muscle cramps and weakness. His current medications include a vitamin D supplement.  While his blood pressure is being obtained, the patient develops carpal spasm.  Laboratory evaluation shows a blood urea nitrogen level of 115 mg/dL, serum creatinine level of 8 mg/dL, and serum calcium level of 6.5 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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