A 76-year-old man is admitted to the hospital with a large pulmonary mass, hilar lymphadenopathy, volume depletion, and obtundation. In the emergency department, the following laboratory tests show Serum calcium16.8 mg/dL, phosphorus 3.1 mg/dL, and creatinine 2.1 mg/dL. He was managed with Intravenous fluids, calcitonin, and when he started to pass urine, he was given furosemide. Which of the following is the most appropriate next management step?
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الإجابة: D. Pamidronate, intravenously
Severe hypercalcaemia of malignancy (Ca 16.8 with a lung mass) has been treated with IV saline, calcitonin (fast but short-lived) and a loop diuretic once urine output returned. The next step is an IV bisphosphonate (pamidronate/zoledronate), which inhibits osteoclasts and gives a sustained fall in calcium within 2–4 days.
- Cinacalcet (A) treats PTH-driven (parathyroid) hypercalcaemia, not PTHrP-mediated disease.
- Glucocorticoids (C) help vitamin-D–mediated causes (granulomas, lymphoma).
- Haemodialysis (B) is kept for refractory cases or renal failure; he is now passing urine.
ليش كل خيار صح أو غلط
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A
ليش غلط
Cinacalcet is a calcimimetic that works by inhibiting PTH secretion (for hyperparathyroidism in non-surgical patients); this hypercalcaemia is from a lung mass (malignancy), not a PTH problem.
✓ Step Up To Medicine 6th Edition 2024(Parthyroid).pdf · p. 5 -
B
ليش غلط
Hemodialysis is for calcium that remains elevated despite medical management; the IV bisphosphonate step has not yet been given.
✓ 3• Parathyroid Disorders [Notes].pdf · p. 11 -
C
ليش غلط
Glucocorticoids work in vitamin D-related causes (granulomas) and myeloma, and are ineffective in most other forms of hypercalcaemia, including a lung-mass malignancy picture like this.
✓ Step_Up_To_Medicine_6th,_2024_Electrolytes_Na,K_Imbalance.pdf · p. 9 -
D
ليش صح
The acute hypercalcaemia medications listed include an IV bisphosphonate and calcitonin (given only for 24 to 48 hours); calcitonin has already been given, so IV pamidronate is the next step.
✓ Calcium and Parathyroid.pdf · p. 55
- المصدر
- Endocrine ✳️.pdf · p. 16
Calcium and Parathyroid.pdf · p. 55 - المحاضرة
- Parathyroid & Calcium Disorders · Endocrinology · Module B
- ظهر في
- Endo bank