An 8-year-old child presented to the Emergency Room with constipation, anorexia, lethargy, and behavioral abnormality. Bony erosion of the phalanges was seen on wrist radiography.... An 8-year-old child presented to the Emergency Room with constipation, anorexia, lethargy, and behavioral abnormality. Bony erosion of the phalanges was seen on wrist radiography. The lab results are: Blood urea nitrogen 3.2 mmol/l, Creatinine 45 umol/L, Glucose 4 mmol/L, Alkaline phosphatase 200 U/L, Parathyroid hormone (Intact PTH levels) 6.2 pmol/L, Parathyroid hormone (N-terminal fraction) 3.1 , Parathyroid hormone (C-terminal fraction) 11, Calcium total 5.3 mmol/L, Phosphate 1.2 mol/L, Magnesium 0.9 mol/L. Which of the following is the best management approach? A. Rehydration and statins B. Diuretics and rehydration. C. Bisphosphonates, diuretics and statins D. Rehydration, diuretics and bisphosphonates.
Understand the Problem
The question presents a clinical case of an 8-year-old child with specific symptoms and lab results. Based on the information, we need to determine the most appropriate medical management approach. The key lies in interpreting the lab results (especially calcium, phosphate, and PTH) to determine the underlying condition and then choosing the treatment option that addresses it. We should focus on the elevated calcium levels (hypercalcemia) and other relevant lab abnormalities.
Answer
The answer is D. Rehydration, diuretics and bisphosphonates.
The best management approach is rehydration, diuretics, and bisphosphonates. Therefore, the answer is D.
Answer for screen readers
The best management approach is rehydration, diuretics, and bisphosphonates. Therefore, the answer is D.
More Information
The patient's symptoms (constipation, anorexia, lethargy, behavioral abnormality) along with the lab results (very high calcium) and bony erosions suggest hypercalcemia, possibly due to primary hyperparathyroidism or another cause. Rehydration helps to dilute the calcium levels and protect the kidneys. Diuretics, specifically loop diuretics, help to increase calcium excretion in the urine. Bisphosphonates are used to reduce bone resorption, which contributes to hypercalcemia.
Tips
A common mistake is to overlook the importance of addressing the underlying cause of hypercalcemia while focusing solely on symptomatic treatment.
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