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Hypercalcaemia in a 63 year old man
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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.
View this table:
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?
Footnotes
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Answers on p 313 .