A 70-year-old man with polyostotic Paget's disease is started on intravenous zoledronic acid. Which monitoring parameter is most important to check before administration to avoid a serious adverse effect?
- A Serum calcium only
- B Serum alkaline phosphatase
- C Serum creatinine and creatinine clearance ✓
- D Serum phosphate
Correct answer: C. Serum creatinine and creatinine clearance
Explanation
Zoledronic acid is renally cleared and can cause acute kidney injury. Renal function must be assessed before each infusion. Calcium should also be checked and vitamin D repleted to avoid hyp post-infusion hypocalcemia, but renal function is the critical safety parameter to prevent nephrotoxicity. ALP is monitored for treatment response, not safety.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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