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  #1  
Old 09-22-2012
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Question Management of Hypercalcemia?

A 58 year old nurse with node positive metastatic breast cancer comes to the office for her monthly follow up visit. The tumor is estrogen receptor (ER) and progesterone receptor (PR) positive, and her whole body bone scan is positive for metastatic disease. She is being treated with systemic chemotherapy and hormonal therapy (Tamoxifen). She feels weak with vague muscle, joint and bone pains. Physical Examination reveals a hard well dominant mass in the left breast. Mucus membrane are moist. Laboratory studies shows the following results

Sodium 145mEq/dL
Potassium 3.9 mEq/dL
Chloride 103 mEq/dL
Bicarbonate 24 mEq/dL
Calcium 11.3 mg/dL
BUN 18 mg/dL
Creatinine 0.8mg/dL
Glucose 146 mg/dL

Which of the following is the next step in the management of the her hypercalcemia?

A. Corticosteroid therapy
B. Zoledronic acid therapy
C. Intravenous normal saline
D. Furosemide
E. Intravenous mithramycin

Qbank (UW) Question. Please answer with reasoning.
Thank You
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Old 09-22-2012
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I think B......Its from UW ????I remember doing a similar question in UW
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Old 09-22-2012
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ans B ........thats the best for cancer related hypercalemia ,

Iv fluids and furosemide for hypercalemic crisis

and mithramycin is too toxic
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Old 09-22-2012
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But my doubt is when to choose saline and when to choose Bisphosphonate for hypercalcemia ??
there several Qs in uworld where saline was the correct answer
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Old 09-22-2012
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Its B

Normal saline is given when you have symptoms of Hypercalcemia, or the values are extremely high, 11.3 is slightly above normal, and therefore you can wait for Biphosphonates to work.

Normal saline with Loop diuretics are when either the patient has signs of hypotension or the hypercalcemia is starting to cause havoc..

I too have been facing some dificulties in these questions, but thats the general rule im applying right now to solve them.
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Old 09-22-2012
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Quote:
Originally Posted by XpaezX View Post
Its B

Normal saline is given when you have symptoms of Hypercalcemia, or the values are extremely high, 11.3 is slightly above normal, and therefore you can wait for Biphosphonates to work.

Normal saline with Loop diuretics are when either the patient has signs of hypotension or the hypercalcemia is starting to cause havoc..

I too have been facing some dificulties in these questions, but thats the general rule im applying right now to solve them.
So mucous membrane dry and hypotension is what we will be looking for initiating IV Saline otherwise stick to bisphosphonate
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Quote:
Originally Posted by step_enhancer View Post
So mucous membrane dry and hypotension is what we will be looking for initiating IV Saline otherwise stick to bisphosphonate
Yeah, I dont have the Uworld ID but When I started Uworld I got 2 questions like that and got them wrong, the patient was typically old, with dry mucous membranes, or they either have tachycardia and hypotension and all the bla bla bla that he/she had cancer and so on, I picked biphosphonates and got them wrong, they wanted me to lower the Calcium ASAP and also to treat the hypovolemia.. so thats why now im using that reasoning while solving these type of questions.
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Quote:
Originally Posted by XpaezX View Post
Yeah, I dont have the Uworld ID but When I started Uworld I got 2 questions like that and got them wrong, the patient was typically old, with dry mucous membranes, or they either have tachycardia and hypotension and all the bla bla bla that he/she had cancer and so on, I picked biphosphonates and got them wrong, they wanted me to lower the Calcium ASAP and also to treat the hypovolemia.. so thats why now im using that reasoning while solving these type of questions.
thank you ,so much .So grateful for your help
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Old 09-23-2012
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C.) intravenous fluid then followed by furosemide
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Old 02-13-2013
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IV fluids to dilute Ca++ concentration
Then lasix to diurese off Ca++ in urine
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