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Hypercalcaemia of malignancy in advanced cancer — SCE Acute Medicine MCQ

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HardMedicine in the elderlyHypercalcaemia of malignancy in advanced cancerSCE Acute Medicine

A 83-year-old man with metastatic lung cancer is admitted with drowsiness, thirst and constipation. Corrected calcium is 3.42 mmol/L, creatinine is 156 micromol/L and ECG shows shortened QT interval. He is clinically dehydrated and not receiving active oncology treatment. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous saline, review goals of care and consider intravenous bisphosphonate if appropriate

Severe symptomatic hypercalcaemia of malignancy is initially treated with intravenous saline if consistent with the patient's goals, followed by bisphosphonate when appropriate. Loop diuretics are not first-line before volume repletion and can worsen dehydration. In advanced cancer, the benefit and burden of treatment should be explicitly considered.

Reference: NICE CKS hypercalcaemia; BNF bisphosphonates; GMC end-of-life care