Hypercalcemia Treatment
Hypercalcemia Definition
Calcium level >10.5 mg/ dL.
Hypercalcemia causes
- Primary Hyperparathyroidism
- Drugs – thiazides, lithium and vitamin D
- Malignancies especially myeloma
- Immobilization
- Renal failure
- Hyperthyroidism
- Excess vitamin D or vitamin A
- Lymphoma granulomatous disease
- adrenal insufficiency
- acromegaly
- pheochromocytoma
Hypercalcemia Symptoms and signs
If serum calcium more than 12 mg/dL
Polyuria, renal colic, anorexia, vomiting, constipation, fatigue, dehydration, nephrolithiasis, peptic ulcer, depression, leathargy, later stupor and coma.
Hypercalcemia diagnosis
Calcium level >10.5 mg/ dL.
Measure PTH, PTHrP
In hypercalcemia elevated PTH and malignancy associated hypercalcemia decrease PTH elevated PTHrP
Severe hypercalcemia more than 14 mg/dL is generally associated with malignancy
Hypercalcemia ECG: short QT interval.
Hypercalcemia Treatment
1. Hydration: 3-4 liters of fluid given over 24 hours, NS with initial drip rates of up to 500ml/hour. 2.Frusemide 20-40 mg IV stat after hydration to promote calcium excretion.
3. Avoid thiazides.
4. Bisphosphonates- Zoledronic acid 4 mg in 250 ml saline given over 1 hour.
5. Steroids-useful in malignancies causing hypercalcemia. Prednisolone 1 mg/kg /day can be given
6. Calcitonin
8. Oral phosphate
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