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Malignant Hypercalcaemia — RACP Adult Medicine MCQ

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HardEndocrinologyMalignant HypercalcaemiaRACP Adult Medicine

A patient with metastatic squamous-cell cancer is confused and dehydrated with corrected calcium 3.65 mmol/L and eGFR 28 mL/min/1.73 m². What initial strategy best addresses this emergency?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Start monitored hydration, calcitonin and renal-adjusted antiresorptive treatment at presentation

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

B is correct because severe symptomatic hypercalcaemia requires volume restoration, a rapid bridge such as calcitonin and definitive antiresorptive therapy chosen with kidney function in mind. C omits initial volume treatment and delays therapy for a result that does not change the emergency threshold. D reduces urinary calcium excretion. E ignores rapid calcitonin tachyphylaxis and the need for durable control. A is insufficient definitive therapy and may overload a patient with renal impairment. Electrolytes, ECG, fluid balance and cancer-directed treatment are reviewed concurrently.

Reference: eviQ, Hypercalcaemia of malignancy: https://www.eviq.org.au/clinical-resources/oncological-emergencies/486-hypercalcaemia-of-malignancy-hcm