Hypercalcemia
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Transcript of Hypercalcemia
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Hypercalcemia Elevation of calcium level in the blood.
Immediate Questions:
A.Vital signs? B.Mental status?B. Underlying condition(s)?
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Potential etiologies
1. Malignancy: bone mets, ectopic PTH, osteoclast activating factor 2. Primary hyperparathyroidism 3. Myeloma 4. Vitamin D excess
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Potential etiologies 5. Sarcoid / granulomatous disease 6. Milk alkali 7. Other: hyperthyroidism, thiazide diuretics, lithium, immobilization (especially children)
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Differential Diagnosis
Among outpatients, malignancy and primary hyperparathyroidism are leading diagnoses. Malignancy predominates as an etiology for hypercalcemia among hospitalized individuals.
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TherapyPatients usually are profoundly volume depleted and can require several liters of NS volume replacement. Volume replacement is the initial step in management. Lasix can be added to help increase a saline diuresis (>2500 ml urine/day) and calcium excretion but should only be used following volume replacement._______________________________________
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Agent Dose Comments
Saline + furosemide 40-80 mg IV each 2 hours monitor hourly urine output, (diuretic only if plus NS equal to urine monitor electrolytes frequently adequately hydrated) output
Mithramycin 25 mcg/kg IV every response takes 24 hours; can 2-3 days cause bone marrow suppression
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Agent Dose Comments
Pamidronate 60-80 mg IV over 6 to response in 3 to 4 days, which (mainstay of therapy) 24 hours lasts up to 7 to 14 days
Prednisone 40-60 mg per day antagonize actions vitamin D; decreases calcium absorption and increases calcium excretion; in most cases, effect lasts only for a few days