A fictional 68-year-old with weight loss presents with confusion, constipation and profound dehydration. Adjusted calcium is 3.6 mmol/L with acute kidney injury.
Listen for the assumption.
I planned immediate furosemide to lower the calcium.
First assess volume, ECG, renal function and the likely mechanism. Rehydration is central, but must be individualised because fluid overload is possible.
I will involve endocrinology and consider malignancy while monitoring the physiological response.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Severe symptomatic hypercalcaemia
- Clinical dehydration with acute kidney injury
- ECG monitoring commenced
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Track corrected or ionised calcium, fluid balance, renal function and ECG, and review calcium-raising medicines.
Correct. Avoid routine furosemide solely to lower calcium; seek renal support if severe renal failure limits safe therapy.
I will hand over both the biochemical trajectory and the investigation of cause.
What must remain explicit.
- Use current endocrine emergency and local fluid guidance.
- Monitor for fluid overload and electrolyte change.
- Adjust definitive treatment to renal function and cause.
Where reasoning fails.
- Routine loop diuretic use
- Waiting for cause before stabilising
- Ignoring renal impairment during bisphosphonate planning
Severe hypercalcaemia with calcium [trend], symptoms/ECG [details], volume and renal status [trend], fluids [balance/response], PTH/cause work-up [status] and specialist treatment [plan].
Does your emergency department have a readily available severe-hypercalcaemia pathway?