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Hypercalcaemia of malignancy — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesHypercalcaemia of malignancySCE Acute Medicine

A 82-year-old woman presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show corrected calcium 3.72 with confusion, dehydration and malignancy. What is the most appropriate next step in management?

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

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Correct answer: E — Give intravenous saline rehydration followed by intravenous bisphosphonate

The key discriminator is that corrected calcium 3.72 with confusion, dehydration and malignancy, which makes Give intravenous saline rehydration followed by intravenous bisphosphonate the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Call critical care for escalation and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology hypercalcaemia guidance