27th February 2025

A 74-year-old man presents to A&E with symptoms of hypercalcaemia and severe right shoulder pain.

A 74-year-old man presents to A&E with symptoms of hypercalcaemia and severe right shoulder pain. His X-ray demonstrates a pathological fracture of his right humerus with multiple sclerotic lesions throughout the bone. His PSA is highly raised, and his calcium level is 3.82 mmol/L (normal range: 2.20-2.60 mmol/L). Treatment is started with aggressive IV fluid replacement as well as IV zoledronate. 

After 24 hours, his calcium remains elevated at 3.63 mmol/l. What is the next best step in management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.