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3. A 71-year-old woman presents with thirst, polyuria and back pain. Urgent radiography shows lytic lesions in the spine and vertebral collapse. FBC shows: WBC 9.8 x 109/l, Hb 94 g/l and platelet count 110 x 109/l. The blood film shows increased rouleaux formation and increased background staining. S.Creatinine is 1.2mg/dl and corrected plasma calcium is 3.2 mmol/l. The management should not include ?
/3. Sodium bicarbonate
/4. Zoledronic acid
Answer =  Sodium bicarbonate : Symptomatic patients whose serum calcium level exceeds 12 mg/dL or asymptomatic persons whose level exceeds 14 mg/dL should be immediately and aggressively treated with antihypercalcemic therapy: saline rehydration followed by loop diuretics, calcitonin, bisphosphonates, or denosumab. Glucocorticoids are a treatment option for hypercalcemia in patients with excessive vitamin D or endogenous overproduction of calcitriol secondary to lymphoma.