Sunday, August 14, 2016

Q: 54 year old female is transferred to ICU from oncology floor with coma which requires intubation. Labs send 2 hours ago showed calcium of 18.4 mg/dL. What should be the next step (Best answer)

A) Intravenous fluid (IVF)
B) intravenous fluid with Furosemide
C) Hemodialysis
D) Intravenous Bisphosphonate
E) Zoledronic acid

Answer: C

Hemodialysis(HD) rarely gets mentioned as treatment for life threatening hypercalcemia but once calcium level cross 18 mg/dL with obvious clinical signs, HD becomes an absolute indication. IVF, IV Bisphosphonates or Zoledronic acid are all valid treatments of hypercalcemia but in extreme situation, HD is indicated.

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