BOF: 3.29
You are called to see a
patient who has been admitted to your ward earlier in the day. She is known to
have breast cancer with bone metastases. She has been complaining of thirst,
polyuria and constipation. She is irritable and in pain. Her serum calcium is
now available and is 3.9 mmol/l.
Your first line of action in
this patient would be:
a)
NSAIDs for treatment of her pain
b)
Treatment with intravenous bisphosphonates
c)
Treatment with calcitonin
d)
Rapid infusion of saline
e)
Treatment with high dose steroids
Answer: d)
NSAIDs should not be used in
hypercalcaemia as they decrease renal blood flow and thus inhibit urinary
calcium excretion.
Treatment of hypercalcaemia
of malignancy is initial saline diuresis; rapid infusion of saline and once
the patient is fluid replete furosemide may be used to decrease tubular
reabsorption of calcium.
Bisphosphonates are the
treatment of choice in hypercalcaemia of malignancy but they do not act
immediately.
Calcitonin accelerates the
fall in calcium produced by bisphosphonates.
Steroids are effective in the
treatment of the hypercalcaemia of sarcoidosis, vitamin D intoxication,
lymphomas and Addison’s disease
