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22nd June 2023
A 73-year-old man with metastatic squamous cell carcinoma of the lung is admitted with colicky abdominal pain, constipation, and mild confusion.
A 73-year-old man with metastatic squamous cell carcinoma of the lung is admitted with colicky abdominal pain, constipation, and mild confusion. He has recently commenced pembrolizumab, an immunotherapy agent. He has a history of type 2 diabetes mellitus and hypertension. His current drug history includes aspirin, ramipril, bendroflumethiazide, furosemide, gliclazide and metformin. He lives alone and is normally independent. His initial observations are: HR 100, BP 100/50 mmHg, SATS: 98% on air, RR 18, apyrexial.
After 48 hours of fluid resuscitation, repeat bloods are undertaken:
His biochemistry shows:
| Na⁺ | 138 mmol/L | (133-146 mmol/L) |
| K⁺ | 4.1 mmol/L | (3.5-5.3 mmol/L) |
| Urea | 12.2 mmol/L | (2.5-7.8 mmol/L) |
| Creatinine | 151 µmol/L | (80-115 µmol/L) |
| eGFR | 39 ml/min | (>90 ml/min) |
| Corrected Ca²⁺ | 3.58 mmol/L | (2.20-2.60 mmol/L) |
| Mg²⁺ | 0.89 mmol/L | (0.70-1.05 mmol/L) |
What is the best treatment to correct malignant hypercalcaemia in this patient?
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