skip to main content

Hypercalcaemia — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyEndocrinology & DiabetesHypercalcaemiaRACP Adult Medicine

A 62-year-old woman presents with bone pain, constipation, and confusion. Serum calcium is 3.45 mmol/L, phosphate 0.6 mmol/L, and PTH 185 pg/mL (elevated). Creatinine is 180 µmol/L. What is the most appropriate initial management?

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

Reveal the answer and explanation

Correct answer: B — IV normal saline at 200–300 mL/hr

Severe hypercalcaemia (>3.0 mmol/L) with symptoms requires urgent treatment. IV normal saline (200–300 mL/hr initially) is the first step to restore intravascular volume and promote calciuresis. Once rehydrated, IV zoledronic acid or denosumab can be given. Calcitonin provides a rapid but transient effect. This patient has primary hyperparathyroidism and will need parathyroidectomy after stabilisation.

Reference: eTG – 2025 – Endocrinology; AMH – 2025 – Calcium Metabolism