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Hypercalcaemia of malignancy — SCE Acute Medicine MCQ

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ModerateDiabetes and endocrine medicineHypercalcaemia of malignancySCE Acute Medicine

A 60-year-old man with small-cell lung cancer presents with nausea, constipation and confusion. Corrected calcium is 3.42 mmol/L, phosphate is low and creatinine is 160 micromol/L. ECG shows shortened QT interval. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous 0.9% sodium chloride rehydration and arrange intravenous bisphosphonate after renal assessment

Severe symptomatic hypercalcaemia of malignancy requires IV saline rehydration, followed by antiresorptive therapy such as bisphosphonate once renal function and hydration are considered. Thiazides and calcium supplements worsen hypercalcaemia. Insulin-glucose is for hyperkalaemia, not hypercalcaemia.

Reference: Society for Endocrinology Hypercalcaemia Guidance; BNF Bisphosphonates