A patient with myeloma-associated hypercalcaemia has been appropriately rehydrated and receives an intravenous bisphosphonate. Corrected calcium is

Question

A patient with myeloma-associated hypercalcaemia has been appropriately rehydrated and receives an intravenous bisphosphonate. Corrected calcium is still 3.02 mmol/L 18 hours later, but symptoms and renal function are stable. What is the most appropriate interpretation and next step?

Accepted Answer

Observe while treating the myeloma; reassess calcium at the expected 2–4 day nadir

Answer

Repeat intravenous bisphosphonate at 24 hours if corrected calcium remains above 3.0 mmol/L

Answer

Begin cinacalcet at 24 hours and repeat parathyroid hormone measurement at 48 hours

Answer

Add calcitonin at 24 hours and schedule a further bisphosphonate dose on day 2

Answer

Use furosemide to establish negative fluid balance while awaiting the calcium nadir

Breast Cancer — SCE Medical Oncology MCQ

A patient with myeloma-associated hypercalcaemia has been appropriately rehydrated and receives an intravenous bisphosphonate. Corrected calcium is still 3.02 mmol/L 18 hours later, but symptoms and renal function are stable. What is the most appropriate interpretation and next step?