A 78-Year-Old Woman with Metastatic Breast Cancer Involving the Bones

A 78-year-old woman with metastatic breast cancer involving the bones and soft tissues who has been taking hormone replacement therapy is evaluated in the emergency department because of lethargy and weakness, nausea, thirst, and dizziness. She is orthostatic and clinically dehydrated. She has a history of congestive heart failure that has been controlled with medications. Laboratory studies: Blood urea nitrogen 42 mg/dL Total serum calcium 11 .4 mg/dL Serum creatinine 1.6 mg/dL Serum albumin 3.0 g/dL What is the most appropriate initial treatment?

A) Slow rehydration with half-normal saline
B) Intravenous administration of a bisphosphonate
C) Vigorous rehydration with normal saline
D) Intravenous administration of furosemide along with saline rehydration
E) Intravenous administration of corticosteroids