Surgery>>>>>Fluid and Electrolyte Management of the Surgical Patient
Question 29#

The first step in the management of acute hypercalcemia should be

A. Correction of deficit of extracellular fluid volume
B. Hemodialysis
C. Administration of furosemide
D. Administration of mithramycin

Correct Answer is A

Comment:

Patients with acute hypercalcemia usually have either acute hyperparathyroidism or metastatic breast carcinoma with multiple bony metastases. These patients develop severe headaches, bone pain, thirst, emesis, and polyuria. Unless treatment is instituted promptly, the symptoms may be rapidly fatal. Immediate correction of the associated deficit of extracellular fluid volume is the most important step in treatment. When effective, this results in the lowering of the serum calcium level by dilution. Once extracellular fluid volume has been replaced, furosemide is effective treatment. Hemodialysis may also be employed, but its effect is less rapid. Mithramycin is very useful in controlling metastatic bone disease, but its effect is slow, and it cannot be depended upon when the patient has acute hypercalcemia.