Malignancy-associated hypercalcaemia — ESENeph MCQ

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

HardAcute Kidney Injury, Electrolytes and Acid-BaseMalignancy-associated hypercalcaemiaESENeph

A patient with confusion, dehydration and corrected calcium 3.38 mmol/L has suppressed PTH and suspected malignancy. What is the initial treatment?

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

Reveal the answer and explanation

Correct answer: E — Intravenous saline followed by renal-adjusted bisphosphonate

The best answer is “Intravenous saline followed by renal-adjusted bisphosphonate”. Isotonic saline restores circulating volume and renal calcium excretion. Once rehydrated, an intravenous bisphosphonate is used when appropriate, with choice and dose adjusted for renal impairment. “Restrict fluid to prevent calcium entering the urine” is less appropriate because severe hypercalcaemia causes volume depletion and requires rehydration “Start a thiazide diuretic” is less appropriate because thiazides reduce urinary calcium excretion and can worsen hypercalcaemia “Give active vitamin D” is less appropriate because active vitamin D increases intestinal calcium absorption “Delay treatment until the malignancy is histologically confirmed” is less appropriate because severe symptomatic hypercalcaemia is an immediate emergency

Reference: Society for Endocrinology emergency guidance: acute hypercalcaemia: https://www.endocrinology.org/media/4277/emergency-guidance_acute-hypercalcaemia-in-adults.pdf