Vitamin D Toxicity Hypercalcaemia — ESENeph MCQ
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Correct answer: D — Stop vitamin D, restore volume and monitor biochemical response
The best answer is “Stop vitamin D, restore volume and monitor biochemical response”. Severe hypercalcaemia requires urgent assessment and isotonic volume repletion when not contraindicated, removal of the cause and cause-directed antiresorptive or glucocorticoid treatment when indicated. “Stop vitamin D while assessing the cause of suppressed PTH” is less appropriate because PTH is already appropriately suppressed and the supplement is driving toxicity “Use cautious fluid replacement while monitoring for overload” is less appropriate because dehydration and reduced GFR commonly worsen severe hypercalcaemia “Investigate non-PTH-mediated hypercalcaemia when PTH is suppressed” is less appropriate because the biochemical pattern is PTH-independent “Begin treatment while measuring vitamin-D metabolites and malignancy markers” is less appropriate because severe symptomatic hypercalcaemia requires immediate therapy
Reference: Society for Endocrinology emergency guidance: acute hypercalcaemia: https://pmc.ncbi.nlm.nih.gov/articles/PMC5314807/