Hypercalcemia and Altered Mental Status

According to his medical records, a colonoscopy performed 8 years earlier was unremarkable. According to the International Myeloma Working Group (IMWG), the diagnostic criteria for multiple myeloma include bone marrow plasma cells > 10% or biopsy proven bony or extramedullary plasmacytoma and ^ 1 ofthe following: hypercalcemia, renal insufficiency, anemia, lytic bone lesions, involved:uninvolved FLC ratio ^100 (4). Because most monoclonal proteins are cationic, patients may demonstrate a reduced anion gap secondary to increased renal retention of chloride (8). [...]this case highlights that MM typically presents without a prior diagnosis of monoclonal gammopathy of undermined significance when multiple studies have shown that multiple myeloma is consistently preceded by it (2).