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4th April 2024
A 21-year-old male presents complaining of persistent diarrhoea for the last 6 months.
A 21-year-old male presents complaining of persistent diarrhoea for the last 6 months. He had initially attributed this to a change in diet during recent extended travel around South America but is now concerned as he has continued to lose weight after being home for 5 months. He reports the diarrhoea is bulky and difficult to flush. He denies any blood in his stools. He also complains of myalgia, fatigue, and persistent aching lower back pain, worse with exertion. He appears pale and has bilateral fissures at the corners of his mouth. He is tender over his lumbar spine and pelvis. His BMI is 19.5 kg/m². His stool culture and antigen test are negative. His blood test results are shown below.
| Result | Reference Range | |
|---|---|---|
| Na | 140 mmol/L | 135-145 mmol/L |
| K | 4.9 mmol/L | 3.5-5.0 mmol/l |
| eGFR | 88 ml/min/1.73m² | >90 ml/min/1.73m² |
| AdjCa | 1.99 mmol/L | 2.1-2.6 mmol/L |
| Phosphate | 0.79 mmol/L | 0.8-1.4 mmol/L |
| PTH | 23.1 pmol/L | 0.9-5.4 pmol/L |
| ALT | 32 iu/L | 3-40 iu/L |
| AST | 19 iu/L | 3-30 iu/L |
| ALP | 161 umol/L | 30-100 umol/L |
| Tissue transglutaminase Ab | Positive |
How should he be managed?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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