What is the most appropriate treatment for a patient with hypercalcemia that remains elevated after hydration and diuretic therapy?

The most appropriate treatment for a patient with persistent hypercalcemia, despite hydration and diuretic therapy, is the combination of calcitonin and zoledronic acid.

Calcitonin is a hormone that helps regulate calcium levels in the blood. It acts quickly to lower serum calcium by decreasing osteoclast activity, which leads to reduced bone resorption of calcium. Administering calcitonin intravenously can provide a rapid, although temporary, reduction in calcium levels, especially in acute scenarios.

Zoledronic acid, a bisphosphonate, works by inhibiting osteoclast-mediated bone resorption, which helps to lower serum calcium levels more effectively over a longer duration. The standard dose for treating hypercalcemia is typically 4 mg IV given over 15 minutes, which helps prevent complications associated with elevated calcium levels.

Together, these medications address the immediate need to lower calcium levels effectively and complement each other's actions—calcitonin provides rapid control while zoledronic acid contributes to longer-term management.

Other options, such as hemodialysis or only using bumetanide, do not address the hypercalcemia as effectively or as rapidly. Hemodialysis is often reserved for severe cases or when other therapeutic options fail, while