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Hypercalcaemia in a 63 year old man
  1. L Ranganatha,
  2. M J Sempleb
  1. aEpsom General Hospital, Epsom, Surrey UK: Department of Chemical Pathology, bDepartment of Haematology
  1. Dr L Ranganath, Department of Clinical Chemistry, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK (e-mail:lrang{at}liverpool.ac.uk)

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A 63 year old man with IgG myeloma was found to have hypercalcaemia; specific hypocalcaemic measures such as intravenous fluids and pamidronate 60 mg followed by 1.6 g of oral sodium clodronate daily in addition to antimyeloma agents such as prednisolone, Adriamycin, and carmustine were unsuccessful in restoring eucalcaemia (fig 1).

Figure 1

Profile of serum corrected calcium before and after treatment.

Blood test results while on treatment with clodronate are shown in table1.

Table 1

Blood test results while on treatment with clodronate

Questions

(1)
What is the cause of the apparent resistance to bisphosphonates?
(2)
What further investigations for hypercalcaemia should be undertaken?
(3)
What are the causes of hypercalcaemia in myeloma?

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