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. Given the following lab results, which of the following is the best management approach? Test Result 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 pmol/L Parathyroid hormone (C-terminal fraction) 11 pmol/L Calcium total 5.3 mmol/L Phosphate 1.2 mol/L Magnesium 0.9 mol/L A. Rehydration and statins B. Diuretics and rehydration. C. Bisphosphonates, diuretics and statins D. Rehydration, diuretics and bisphosphonates.
Understand the Problem
The question describes an 8-year-old child presenting with symptoms and lab results indicative of a potential metabolic disorder, most likely hyperparathyroidism, given the elevated PTH and calcium levels, along with bony erosions. The question is asking for the most appropriate management approach based on the given information.
Answer
Rehydration, diuretics, and bisphosphonates.
The best management approach is D. Rehydration, diuretics, and bisphosphonates.
Answer for screen readers
The best management approach is D. Rehydration, diuretics, and bisphosphonates.
More Information
The patient's symptoms and lab results indicate hypercalcemia. Rehydration helps dilute the calcium, diuretics promote calcium excretion, and bisphosphonates reduce bone resorption, thus lowering calcium levels.
Tips
A common mistake is overlooking the need for bisphosphonates to address the underlying cause of hypercalcemia by reducing bone resorption.
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