BOF: 123
A 67-year-old female presents with anorexia, nausea
vomiting and loss of weight. No other symptoms of note. On examination she was
mildly dehydrated and looked unwell.
Investigations:
Hb 16.6 g/dl
WBC 4.7 x 109/l
ESR 13mm in the 1st hour
Sodium 136 mmol/l
Potassium 3.9 mmol/l
Chloride 111 mmol/l
Bicarbonate 27 mmol/l
Urea 10.2 mmol/l
Creatinine 126 micromoles/l
Albumin 44 g/l
Calcium 3.87mmol/l
Phosphate 0.62 mmol/l
Alkaline phosphatase 120 U/l
Which of the following is an unlikely cause for her
hypercalcaemia
a)
Thyrotoxicosis
b)
Malignant disease
c)
Hyperparathyroidism
d)
Vitamin D therapy
e)
Renal failure
Answer:
a)
Severe hypercalcaemia (Serum calcium > 3 mmol/l) may
be associated with malignant disease, hyperparathyroidism, renal failure and
vitamin D therapy
Thyrotoxicosis and Addison’s disease may cause
hypercalcaemia but it is usually mild.
What is the best emergency treatment for this patient?
a)
Intravenous Bisphosphonates
b)
Steroids
c)
Calcitonin
d)
Intravenous phosphate
e)
Oral phosphates
Answer:
a)
Intravenous bisphosphonates are now considered the
treatment of choice for severe hypercalcaemia. Adequate rehydration is an
essential prerequisite.
Calcitonin has a short-lived action and is not used.
Prednisolone may be effective in myeloma, sarcoidosis, and Vitamin D excess
but is ineffective in most case. Oral phosphate causes diarrhoea intravenous
phosphate is dangerous and is not used for hypercalcaemia
