63 year old lady with abdominal pain and mild confusion

Samuel Wilson on May 26, 2013

You admit Ms. Moore from clinic unto your inpatient medicine service. As you begin to write her admission orders, you ponder which therapies you should order.

What initial intervention should you use to address her hypercalcemia?

Expand all answers
Initiate hemodialysis
Incorrect. This is too aggressive and there are other more reasonable options.


Start a bisphonsphonate
Incorrect, this should not be the first intervention.


Give calcitonin
Incorrect. This is a second line therapy.


Start aggressive intravenous fluid hydration
Patients with hypercalcemia are typically intravascularly volume depleted by a variety of factors including decreased effectiveness of renal urine concentration (nephrogenic diabetes insipidus) and decreased oral intake of fluids to the nausea and abdominal discomfort. Aggressive hydration at 200mL/hr with NS can rapidly restore intravascular volume and help normalize serum calcium by increasing the GFR and allowing the kidneys to excrete the extra calcium.


What additional medication would be appropriate to manage the hypercalcemia?

Expand all answers
Bisphosphonate (i.e. Zoledronate or Pamidronate)
Given the mild to moderate severity of hypercalcemia (> 14) and presence of symptoms, a bisphosphonate should be given to more rapidly normalize the serum calcium. Bisphosphonates reduce serum calcium by preventing inhibiting osteoclastic bone resorption.


Calcitonin
Incorrect. This is a second line medication.


Glucocorticoids
Incorrect. This is a second line therapy.


Furosemide
Incorrect, furosemide should be avoided at this time as she is dehydrated. However, furosemide or another loop diuretic should be given once the patient is no longer hypovolemic to help excrete more calcium.


You admit Ms. Moore from clinic unto your inpatient medicine service. As you begin to write her admission orders, you ponder which therapies you should order.

What initial intervention should you use to address her hypercalcemia?

Expand all answers
Initiate hemodialysis
Incorrect. This is too aggressive and there are other more reasonable options.


Start a bisphonsphonate
Incorrect, this should not be the first intervention.


Give calcitonin
Incorrect. This is a second line therapy.


Start aggressive intravenous fluid hydration
Patients with hypercalcemia are typically intravascularly volume depleted by a variety of factors including decreased effectiveness of renal urine concentration (nephrogenic diabetes insipidus) and decreased oral intake of fluids to the nausea and abdominal discomfort. Aggressive hydration at 200mL/hr with NS can rapidly restore intravascular volume and help normalize serum calcium by increasing the GFR and allowing the kidneys to excrete the extra calcium.


What additional medication would be appropriate to manage the hypercalcemia?

Expand all answers
Bisphosphonate (i.e. Zoledronate or Pamidronate)
Given the mild to moderate severity of hypercalcemia (> 14) and presence of symptoms, a bisphosphonate should be given to more rapidly normalize the serum calcium. Bisphosphonates reduce serum calcium by preventing inhibiting osteoclastic bone resorption.


Calcitonin
Incorrect. This is a second line medication.


Glucocorticoids
Incorrect. This is a second line therapy.


Furosemide
Incorrect, furosemide should be avoided at this time as she is dehydrated. However, furosemide or another loop diuretic should be given once the patient is no longer hypovolemic to help excrete more calcium.


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