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Hypercalcaemia of malignancy — SCE Acute Medicine MCQ

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ModerateCancer and Palliative Care and HaematologyHypercalcaemia of malignancySCE Acute Medicine

A 66-year-old woman with metastatic lung cancer presents with confusion, constipation and polyuria. Corrected calcium is 3.58 mmol/L, creatinine 156 micromol/L and ECG shows short QT interval. She is clinically dehydrated. What is the most appropriate initial management?

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Correct answer: E — Give intravenous 0.9% sodium chloride rehydration before antiresorptive therapy

Severe hypercalcaemia of malignancy is initially treated with isotonic saline rehydration, followed by bisphosphonate or denosumab depending on context and renal function. Loop diuretics before volume correction can worsen dehydration and renal impairment. Dialysis is reserved for selected refractory or life-threatening cases. The immediate physiology is volume depletion from nephrogenic diabetes insipidus and natriuresis.

Reference: NICE CKS hypercalcaemia, BNF