skip to main content

Myeloma Hypercalcaemia — RACP Adult Medicine MCQ

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

HardHaematologyMyeloma HypercalcaemiaRACP Adult Medicine

A 70-year-old man with newly diagnosed multiple myeloma develops acute confusion, polyuria, and constipation. His corrected calcium is 3.8 mmol/L and creatinine is 350 µmol/L. After 2 litres of IV normal saline, calcium remains 3.5 mmol/L. What is the most appropriate next pharmacological treatment?

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

Reveal the answer and explanation

Correct answer: A — Calcitonin 4 IU/kg SC every 12 hours

In myeloma-associated hypercalcaemia refractory to hydration, calcitonin provides the most rapid reduction (onset within 4–6 hours). Bisphosphonates (zoledronic acid) are important but take 2–4 days for effect. Zoledronic acid should be dose-adjusted or used cautiously in significant renal impairment (creatinine 350 µmol/L). Denosumab is an alternative when bisphosphonates are contraindicated by renal impairment. Corticosteroids also help in myeloma by their anti-tumour effect.

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