A patient of disseminated malignancy comes to the palliative care clinic with nausea, vomiting and altered sensorium. Hypercalcemia is detected on investigations. What will be the first line of management?
(A) Intravenous steroids (B) Thiazides (C) Intravenous fluids (D) Intravenous bisphosphonates
(C) Ans: C. Intravenous fluids(Ref: Harrison 19/e p314; 18Ie p361)Management of Significant, Symptomatic Hypercalcemia:Initial therapy:Volume expansion (hypercalcemia leads to dehydration) with 4-6 L of IV saline over first 24 h, keeping in mind that underlying comorbidities (e.g., congestive hea failure) may require use of loop diuretics to enhance Na+ & Ca+ excretion.Increased calcium mobilization from bone (in malignancy or severe hyperparathyroidism).Drugs that inhibit bone resorption should be considered.Zoledronic acid, pamidronate & ibandronate - In treatment of hypercalcemia of malignancy in adults.Onset of action is within 1-3 days, with normalization of serum calcium levels occurring in 60-90% of patients.