A patient of disseminated malignancy comes to the palliative care clinic with nausea, vomiting and altered sensorium. Hypercalcemia is detected on investigations. What will be the first line of management?

Ans: C. Intravenous fluids(Ref: Harrison 19/e p314; 18Ie p361)Management of Significant, Symptomatic Hypercalcemia:Initial therapy:Volume expansion (hypercalcemia leads to dehydration) with 4-6 L of IV saline over first 24 h, keeping in mind that underlying comorbidities (e.g., congestive hea failure) may require use of loop diuretics to enhance Na+ & Ca+ excretion.Increased calcium mobilization from bone (in malignancy or severe hyperparathyroidism).Drugs that inhibit bone resorption should be considered.Zoledronic acid, pamidronate & ibandronate - In treatment of hypercalcemia of malignancy in adults.Onset of action is within 1-3 days, with normalization of serum calcium levels occurring in 60-90% of patients.