SHM Converge Scientific Abstract ePoster Gallery-Altered Mental Status in an Elderly Woman, Must Be the Urinary Tract Infection, or Is It?

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This case describes an 80-year-old woman with altered mental status and auditory/visual hallucinations initially concerning for a urinary tract infection, especially given a positive urine culture for E. coli. However, her mental status changes began about 3 weeks before urinary symptoms, suggesting the UTI alone did not explain her presentation.<br /><br />Further workup revealed significant hypercalcemia (calcium 12.3 mg/dL) with markedly elevated vitamin D levels and suppressed parathyroid hormone. She had a history of thyroidectomy with incidental parathyroidectomy for Graves’ disease and was taking calcium citrate-vitamin D plus high-dose ergocalciferol, raising concern for inadvertent vitamin D/calcium over-supplementation. Her son also reported declining mentation while she managed her own medications.<br /><br />Hypercalcemia is a recognized but sometimes overlooked cause of confusion, hallucinations, and acute kidney injury in older adults. In this patient, the metabolic disturbance likely contributed substantially to her encephalopathy, while the E. coli UTI was a concomitant finding rather than the sole cause.<br /><br />The key teaching point is that altered mental status in elderly patients should not automatically be attributed to UTI, even when urine studies are positive. Alternative causes such as hypercalcemia, especially from vitamin D excess or supplementation errors, must be considered.

Asset Subtitle

Allison E. Whorton

Meta Tag

Author List Allison E. Whorton, Paige F. Gioia, Pinky Jha, Tyson McLeish

Category Clinical Vignettes

Concept Altered Mental Status

Concept Hypercalcemia

Concept Vitamin D

Concept Calcium

Concept Cognitive Changes

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Allison E. Whorton

Track Adult

Keywords

altered mental status

auditory hallucinations

visual hallucinations

urinary tract infection

E. coli

hypercalcemia

vitamin D excess

supplement overuse

parathyroid hormone suppression

elderly encephalopathy

Altered Mental Status

Hypercalcemia

Vitamin D

Calcium

Cognitive Changes