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A 42-year-old man presents with a 1-day history of increasing nausea, vomiting, and lethargy. He has an extensive smoking history and was recently diagnosed with lung cancer. He is not taking any medications and has not yet initiated chemotherapy. On physical examination, he is afebrile and somnolent. His lungs are clear to auscultation, and his heart is regular in rate and rhythm. His skin shows eroding calcium deposits. Laboratory results indicate a serum calcium level of 13.4 mg/dL. Which of the following is the most appropriate initial step in management?
A. Calcitonin
B. Etidronate
C. Hydrochlorothiazide
D. IV saline
E. Prednisone
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hydrochlorothiazide....
hypercalcemia cause hypercalciuria which inc chance of nephrolithiasis
so hydrochlorothiazide dec renal ca excretion, decreasing risk of nephrolithiasis
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I was thinking Calcitonin
- reduce absorption at SI
- reduce reabsorption at Renal
- inhibit osteoclast activity
w/ HCTZ - you would still have the initial problem of hypercalcemia.... am i thinking wrong?
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this is hypercalcemia b/c of paraneoplastic PTHrP in squamous Ca
Calcitonin-shouldn't that be given bcoz of endogenous issues which helps Ca deposition in bones,
hypercalcemia here should be treated by treating the cancer i think ...question said initial best step
i duno maybe I am wrong...why IV saline eagle99
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--Hypercalcemia causing metastatic calcification(high serum calcium + skin calcium deposits)...
--the hypercalcemia is due to PTH-related protein-
--if the hypercalcemia is SYMPTOMATIC (as in this case)...the initial therapy is
1-IV hydration with normal saline followed by IV furosemide(RR page 496 third edition)---this is the most common therapy
following this Bisphosphonates and calcitonin can be used
my answer (golijan's answer)...IV saline dddd
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The initial step in the care of severely hypercalcemic patients is hydration with saline. Hydration helps decrease the calcium level through dilution. The expansion of extracellular volume also increases the renal calcium clearance.
After hydration then ur can try using loop-diuretics and Bisphosphanates.So will go with DDD.
HCTZ-main side effect is hyperG-L-U-C(C FOR HYPERCALCEMÄ°A)so will make the situation worse.
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The correct answer is D.
Hypercalcemia can be treated with IV saline and furosemide. Fluid replacement with IV saline and forced diuresis with saline and a loop diuretic, such as furosemide, is a rapid and safe way to lower serum calcium and should be the initial approach to therapy. This patient has lung cancer and is probably exhibiting a paraneoplastic secretion of parathyroid-related hormone, which is making him hypercalcemic.
Calcitonin (choice A), a hormone secreted by the parafollicular cells of the thyroid, inhibits osteoclast activity and decreases the rate of bone loss and fractures in osteoporosis. It may be added after IV hydration and diuresis with furosemide.
Etidronate (choice B) is a bisphosphonate that prevents bone resorption by inhibiting osteolytic activity. It is often used in preventive therapy for osteoporosis. However, it would be of limited value in this acute setting. Hydrochlorothiazide (choice C) is a thiazide diuretic that decreases urinary calcium excretion and can cause hypercalcemia.
Prednisone (choice E) is a glucocorticoid that is effective in treating hypercalcemia caused by vitamin D excess, sarcoidosis, and some hematologic malignancies. However, it does not lower calcium in most cases of hypercalcemia associated with solid tumors.
