WBR0693

Author	[[PageAuthor::Twinkle Singh, M.B.B.S. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Electrolytes
Prompt	[[Prompt::A 60 year old male comes to the clinic with complaints of abdominal pain, nausea, constipation, fatigue and feeling depressed from few months. He also suffers from increased frequency of urination and has been feeling confused from few weeks. His vital signs are; blood pressure, 145/100 mmHg; pulse, 95/min and RR, 16/min. Serum values are as follows: Hb: 8.5 mg/dL Sodium: 140 mEq/L Potassium: 4.5 mEq/L Calcium: 12.5 mEq/L Creatinine: 1.5 mg/dL What is the next best step in management of this patient’s hypercalcemia?]]
Answer A	AnswerA::Bisphosphonates
Answer A Explanation	[[AnswerAExp::Bisphosphonates are approved by FDA for treatment of hypercalemia. Their onset of action is 1-3 days. Hydration should be the first step in management of hypercalcemia.]]
Answer B	AnswerB::Calcitonin
Answer B Explanation	AnswerBExp::Calcitonin is not the first line of drug in management of hypercalcemia, however, in life threatening cases it should be used along with hydration and bisphosphonates.
Answer C	AnswerC::Hydration
Answer C Explanation	AnswerCExp::Intravenous fluid administration is the first step in management of hypercalcemia.
Answer D	AnswerD::Loop diuretics
Answer D Explanation	[[AnswerDExp::After rehydration, a loop diuretic such as furosemide can be added. Loop diuretics tend to depress renal calcium reabsorption thereby helping to lower blood calcium levels also helps to prevent development of pulmonary edema in patients with congestive heart failure.]]
Answer E	AnswerE::Hemodialysis
Answer E Explanation	AnswerEExp::Hemodialysis is indicated rarely in patients in whom calcium level cannot be managed with hydration, bisphosphonates and calcitonin.
Right Answer	RightAnswer::C
Explanation	[[Explanation::Mild to moderate asymptomatic hypercalcemia does not require any immediate treatment. Any symptomatic moderate hypercalcmia (>12-14 mEq/L) or severe hyercalcemia (>14 mEq/L) should be treated. Intravenous hydration is always the first step. 4-6 L of IV fluids (0.9% NS) should be given over the first 24 hours. Hydration helps by increasing the calcium excretion by kidneys, also hypercalcemia leads to dehydration so volume resuscitation is required. However, comorbidities like CHF should be kept in mind with aggressive hydration. Loop diuretics like furosemide should be added only after volume expansion is adequately reached. Severe and acutely raised calcium levels, or hypercalcemia of malignancy require treatment with hydration, bisphonates and calcitonin. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Hypercalcemia
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::