An elderly nursing home patient has been bedridden for several months due to a series of debilitating strokes. The patient's past medical history is significant for hypertension, controlled with a diuretic, and Paget's disease. Recently, the patient has been complaining of vague abdominal pain, constipation, and a depressed mood. On physical examination, the patient is alert and oriented. The abdominal examination is unremarkable.

Which of the following electrolyte abnormalities would most likely explain her symptoms?

A. Hyponatremia
B. Hypernatremia
C. Hyperphosphatemia
D. Hypocalcemia
E. Hypercalcemia

The elderly nursing home patient's symptoms of abdominal pain, constipation, and depressed mood, in conjunction with their medical history of Paget's disease and diuretic use, most likely point to hypercalcemia as the explanation for their symptoms.

Explanation:

The symptoms described, including vague abdominal pain, constipation, and depressed mood, along with the patient's medical history and medications, lead us to consider an electrolyte imbalance as the likely culprit. In this case, the most probable electrolyte abnormality would be hypercalcemia. This condition refers to an abnormally high level of calcium in the blood and can result in neurological underactivity, which aligns with the patient's symptoms such as lethargy, sluggish reflexes, and constipation. Considering the patient has Paget's disease, which affects bones and can lead to increased bone turnover and subsequently elevated calcium levels, alongside the use of a diuretic, which can also contribute to hypercalcemia, the patient's presentation fits well with this diagnosis.