Keith M. Swetz, MD

A 62-year-old man presented to the emergency room with jaundice, abdominal pain, hypercalcemia and respiratory distress. He had been undergoing outpatient evaluation of a lung mass for the previous two months. Laboratory studies suggested impending liver failure with a lactate of 14 mg/dL and a serum ammonia of 112 mcmol/L, bilirubin of 12.7 mcmol/L, and transaminases two to three times normal.