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?
IV fluids and furosemide
Immediate hemodialysis
Bisphosphonates
Chemotherapy with gemcitabine and carboplatin
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.