Q. A 35-year-old male presents to the emergency department with complaints of a sudden loss of muscular tone in all four limbs without losing consciousness. He is a farmer, and reports being attacked by honeybees one week ago. He initially experienced pain and swelling, but did not seek medical attention. Over the past several days, he has developed weakness, fatigue, and dark urine. He denies any other symptoms such as fever, nausea, or vomiting. The patient has no significant past medical history, and is not currently taking any medications. On physical examination, he is alert and oriented, but appears tired and weak. He has multiple bee sting marks on his arms and legs. His temperature is 37 degrees Celsius (98.6 degrees Fahrenheit), blood pressure 120/80 mm Hg, heart rate 80/min, and respiratory rate 18/min. Neurologic assessment demonstrates cranial nerves 2 through 12 are intact, and the patient is able to follow commands. Motor examination reveals flaccid quadriparesis, with decreased muscle tone and strength in all four extremities. The patient has difficulty lifting his arms and legs against gravity, and has very limited active range of motion in all four extremities. Deep tendon reflexes are absent in all four limbs. Sensation to light touch, pinprick and temperature is intact in all four limbs. Coordination and gait examination is impaired, and the patient is unable to walk or stand without assistance. No focal neurologic deficit or other abnormalities are noted on examination. You order blood work and a urinalysis. The patient's laboratory results reveal a serum bicarbonate level of 15 mEq/L, serum potassium of 2.1 mEq/L, and a serum creatinine level of 3.0 mg/dL. Urinalysis shows glucosuria and aminoaciduria, as well as hyperchloremic metabolic acidosis with a normal anion gap and preserved ability to acidify urine with a pH of 5.5. Further analysis shows high urinary excretion of calcium, phosphorus and uric acid. Based on the information you have at this point in time, which of the following is the most likely diagnosis?