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Hypercalcaemia – malignancy — RACP Paediatrics MCQ

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ModerateEndocrineHypercalcaemia – malignancyRACP Paediatrics

A 12-year-old with malignancy presents with lethargy, polyuria, constipation, and abdominal pain. Serum calcium is 3.8 mmol/L. ECG shows a shortened QT interval. What is the most appropriate initial management of the hypercalcaemia?

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Correct answer: C — IV normal saline hydration

Acute hypercalcaemia requires immediate IV normal saline hydration (20 mL/kg bolus then 2-3 times maintenance) to restore intravascular volume and promote calciuresis. Once rehydrated, frusemide can be added to enhance renal calcium excretion. Bisphosphonates (pamidronate) are used for malignancy-associated hypercalcaemia refractory to hydration.

Reference: RCH Melbourne – 2023 – Hypercalcaemia CPG; RACP Paediatric Curriculum – Endocrine