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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).
Blood test results while on treatment with clodronate are shown in table1.
- What is the cause of the apparent resistance to bisphosphonates?
- What further investigations for hypercalcaemia should be undertaken?
- What are the causes of hypercalcaemia in myeloma?