A 70-year-old man with known multiple myeloma presents with confusion, polyuria, and serum calcium of 15.2 mg/dL. ECG shows shortened QT interval. Which is the most appropriate initial step in management?
- A IV zoledronic acid as a single infusion
- B IV normal saline at 200-300 mL/hr to restore volume and promote calciuresis ✓
- C Subcutaneous calcitonin 4 IU/kg every 12 hours
- D Oral prednisone 60 mg daily for 10 days
Correct answer: B. IV normal saline at 200-300 mL/hr to restore volume and promote calciuresis
Explanation
IV normal saline is the first step in hypercalcemia management. Volume expansion corrects dehydration and enhances renal calcium excretion. This must precede bisphosphonates (onset 24-48 hours). Calcitonin provides rapid but transient reduction. Steroids are effective in myeloma-related hypercalcemia but take days. Without volume resuscitation, bisphosphonates are less effective.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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