Template:Hypercalcemia treatment: Difference between revisions
(Created page with "===Asymptomatic or Ca <12 mg/dL=== *Does not require immediate treatment *Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, p...") |
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*Does not require immediate treatment | *Does not require immediate treatment | ||
*Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet) | *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=== | ===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) | *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)=== | ===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)=== | ||
*Pts are likely dehydrated and require saline hydration as initial therapy | *Pts 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) | ||
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*Correct [[hypokalemia]] | *Correct [[hypokalemia]] | ||
*Correct [[hypomagnesemia]] | *Correct [[hypomagnesemia]] | ||
====Diuresis==== | ====Diuresis==== | ||
*Furosemide is NOT routinely recommended | *[[Furosemide]] is NOT routinely recommended | ||
*Only consider in patients with renal insufficiency or heart failure and volume overload | *Only consider in patients with renal insufficiency or heart failure and volume overload | ||
====Dialysis==== | ====Dialysis==== | ||
Consider if patient: | Consider if patient: | ||
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*Severe hypervolemia not amenable to diuresis | *Severe hypervolemia not amenable to diuresis | ||
*Serum Calcium level >18mg/dL | *Serum Calcium level >18mg/dL | ||
====Corticosteroids==== | |||
Decrease Ca mobilization from bone and are helpful | ====[[Corticosteroids]]==== | ||
*Prednisone 60mg PO daily | ''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)'' | ||
*[[Prednisone]] 60mg PO daily | |||
Revision as of 18:42, 16 December 2015
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)
- Pts 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.