General Surgery

Answer 3 Aggressive IV fluid resuscitation followed by a loop diuretic. This patient has severe hypercalcemia due to a hyperparathyroid crisis and should be treated with IV fluids and a loop diuretic, which increase urinary calcium excretion. Neck exploration and removal of 3.5 parathyroid glands and autotransplantation is the treatment of choice for parathyroid hyperplasia, while neck exploration and removal of enlarged gland is the treatment of choice for parathyroid adenoma. However, neither of these choices would be appropriate because the patient is still in the acute phase of hyperparathyroid crisis and serum calcium levels must be reduced before definitive treatment is undertaken. Bisphosphonates and calcitonin can both decrease serum calcium levels; however, their use in the acute phase is limited. SUGGESTED READINGS 1. Cameron JL, editor. Current surgical therapy. 8th ed. Philadelphia: Elsevier Mosby; 2004. 2. Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston textbook of surgery: the biological basis of modern surgical practice. 17th ed. Philadelphia: Saunders; 2004. Click here to return to the questions

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