Question
| A. |
Loop diuretics such as furosemide |
| B. |
Mithramycin (Plicamycin) |
| C. |
Hydration with Isomol |
| D. |
Hydration with isotonic saline |
|
Correct Answer » D Explanation |
 |
The initial treatment of symptomatic hypercalcemia is aggressive intravenous hydration with isotonic (0.9%) normal saline.
Most patients with hypercalcemia are volume depleted because hypercalcemia causes nephrogenic diabetes insipidus, leading to polyuria and dehydration. Intravenous normal saline restores intravascular volume, improves the glomerular filtration rate (GFR), and increases renal calcium excretion.
After adequate hydration, additional therapies such as calcitonin, intravenous bisphosphonates, or loop diuretics (only if clinically indicated) may be used depending on the severity and underlying cause.
Why the Other Options Are Incorrect
A. Intravenous loop diuretic (Furosemide)
- Loop diuretics are not the initial treatment.
- They may be used after adequate hydration in patients with volume overload or heart failure to enhance calcium excretion.
- Routine use is no longer recommended.
B. Intravenous mithramycin (Plicamycin)
- Mithramycin is an older drug used for hypercalcemia associated with malignancy.
- It is rarely used today because of significant toxicity and has been replaced by safer agents such as bisphosphonates and calcitonin.
C. Hydration with Isomol
- Isomol is not the recommended intravenous fluid for the initial management of hypercalcemia.
- Isotonic (0.9%) normal saline is the fluid of choice.
