Template:Hypercalcemia treatment: Difference between revisions
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===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)=== | ===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)=== | ||
* | *Patients are likely dehydrated and require saline hydration as initial therapy | ||
====Hydration==== | ====Hydration==== | ||
*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour | *Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour | ||
====Calcitonin==== | ====[[Calcitonin]]==== | ||
*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr) | *Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr) | ||
*Tachyphylaxis limits use long term, but is a great choice for emergent cases | *Tachyphylaxis limits use long term, but is a great choice for emergent cases | ||
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Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr) | Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr) | ||
*Pamidronate 90mg IV over 24 hours OR | *Pamidronate 90mg IV over 24 hours OR | ||
*Zoledronate 4mg IV over 15 minutes | *[[Zoledronate]] 4mg IV over 15 minutes | ||
*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref> | *Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref> | ||
Revision as of 16:52, 25 August 2019
Asymptomatic or Ca <12 mg/dL
- Does not require immediate treatment
- Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)
Mildly symptomatic Ca 12-14 mg/dL
- May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)
Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)
- Patients are likely dehydrated and require saline hydration as initial therapy
Hydration
- Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour
Calcitonin
- Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
- Tachyphylaxis limits use long term, but is a great choice for emergent cases
Bisphosphonates
Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)
- Pamidronate 90mg IV over 24 hours OR
- Zoledronate 4mg IV over 15 minutes
- Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure[1]
Electrolyte Repletion
- Correct hypokalemia
- Correct hypomagnesemia
Diuresis
- Furosemide is NOT routinely recommended
- Only consider in patients with renal insufficiency or heart failure and volume overload
Dialysis
Consider if patient:
- Anuric with Renal Failure
- Failing all other therapy
- Severe hypervolemia not amenable to diuresis
- Serum Calcium level >18mg/dL
Corticosteroids
Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)
- Prednisone 60mg PO daily
- ↑ LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.