skip to main content

Hypercalcaemia of malignancy — SCE Acute Medicine MCQ

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

ModerateAcute Renal and Metabolic EmergenciesHypercalcaemia of malignancySCE Acute Medicine

A 66-year-old man is assessed on the acute medical unit. He has metastatic lung cancer, constipation and confusion. Corrected calcium is 3.42 mmol/L and creatinine is mildly raised. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: C — Give isotonic crystalloid boluses with frequent reassessment

Give isotonic crystalloid boluses with frequent reassessment is the best answer because symptomatic severe hypercalcaemia is initially treated with intravenous rehydration before antiresorptive therapy. Start intravenous N-acetylcysteine promptly is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Bisphosphonates take time to work and require renal consideration.

Reference: NICE CKS hypercalcaemia; BNF