A patient diagnosed with carcinoma of lung presented with a serum calcium level of 16.4 mmol/L. What will be the first step in management?
(A) IV fluids and furosemide (B) Immediate hemodialysis (C) Bisphosphonates (D) Chemotherapy with gemcitabine and carboplatin
(A) Ans: A. IV fluids and furosemide(Ref Harrison 19/e p314; 18/e p361)Hypercalcemia - Initial therapy:Begins with volume expansion to prevent dehydration.4-6 L of intravenous saline required over 1st 24 hr.Use of loop diuretics:Enhances sodium & calcium excretion.Treats underlying co-morbidities (e.g., congestive hea failure).Used only when volume is stable & normal.