A 16-year-old is brought into emergency after complaining extreme back pain and collapsing at a soccer game.

A 16-year-old is brought into emergency after complaining extreme back pain and collapsing at a soccer game. She is confused and lethargic. Friends say she has been complaining about muscle pain and stiffness. They say her mother and grandmother both have severe osteoporosis. The girl has been taking steps to prevent the disease in herself – lots of weight-bearing exercise, plenty of vitamin D, dairy, and nuts. The pain and stiffness she blamed on extra workouts. Her backpack contains a large number of mineral supplements. Her heart rate is 90 bpm and respirations 5 per minute. Her labs come back as follows: Blood pH 7.32 Serum Na 130 mEq/L Serum K 4 mEq/L Serum Ca2 12 mEq/L Serum Mg2 5 mEq/L Urine Na 100 mEq/L/24 hr Urine K 50 mEq/24 hr Urine Ca2 (high-Ca diet) 600 mg/24 hr Urine positive for blood