DrPak
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A 70-year-old man is admitted to the hospital with a hip fracture. He was previously diagnosed with multiple myeloma. He is being treated with melphalan and prednisone. He complains of anorexia, nausea, vomiting, and constipation. He is slightly stuporous. ECG shows shortened QT interval. His serum calcium level is 13.5 meq/dl. His BUN is 50 mg/dl and serum creatinine is 2.0 mg/dl. What is the most appropriate next step in management?
A) Hydrochlorothiazide
B) 0.9 % saline
C) Pamidronate
D) Calcitonin
E) IV furosemide
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| dr.wad
Forum Senior
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( E ).
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| Aashi
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B) 0.9 % saline(FIRST)------------>then furosemide--------->then pamidronate
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| robin082006
Forum Hero
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yes, this is hypercalcemic crisis----> normal saline first, then furosemide, then bisphosphanates or calcitonin
Answer B
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| chemamr
Forum Hero
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B should be the next step
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| prathapdoctor
Forum Elite
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yes I V saline first, then loop diuretics and so on as told by aashi, guys, read calcium well, i got around 8 to 10 questions from that.
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| DrPak
Forum Elite
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Yes you guys got it right. Tell me though, why is the IV hydration so important? What does it do exactly for the hypercalcemia? What would happen if we jus gave furosemide and diuresised the Ca out?
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| may_u_b_blessed
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hydration is the first step cos it reduces calcium level thru dilution effect plus the increase in intravascular volume promotes renal calcium clearance. Iv furosemide comes after that cos besides its action of causing urinary calcium excretion it also protects from overhydration from IV saline therapy.
hydration is not suitable in patients with renal failure...opt for dialysis.
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