Hypercalcemia of malignancy

Background

1. Causes:
   1. PTHrP release
      1. SCC (particularly of the head and neck), breast renal, endometrial cancer
   2. Local osteolysis
      1. Associated primarily with bone mets
      2. Multiple myeloma, lung, breast cancer
   3. Production of vitamin D analogues
      1. Lymphoma (Hodgkin)

Clinical Features

1. See Hypercalcemia

Work-Up

1. Chem10
2. Ionized Ca
3. CBC
4. LFTs (alk phos, albumin)
5. ECG

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

• Malignant airway obstruction
• Bone metastases and pathologic fractures
• Malignant spinal cord compression
• Malignant Pericardial Effusion and Tamponade
• Superior vena cava syndrome

Related to Biochemical Derangement

• Hypercalcemia of malignancy
• Hyponatremia due to SIADH
• Adrenal insufficiency
• Tumor lysis syndrome
• Carcinoid syndrome

Related to Hematologic Derangement

• Neutropenic fever
  • Neutropenic enterocolitis (typhlitis)
• Leukostasis and hyperleukocytosis
• Hyperviscosity syndrome
• Thromboembolism

Related to Therapy

• Chemotherapy-induced nausea and vomiting
• Cytokine release syndrome
• Chemotherapeutic drug extravasation
• Differentiation syndrome (retinoic acid syndrome) in APML
• Stem cell transplant complications
• Catheter-related complications
  • Tunnel infection
  • Exit site infection
  • CVC obstruction (intraluminal or catheter tip thrombosis)
  • Catheter-related venous thrombosis
  • Fracture of catheter lumen
  • Oncologic therapy related adverse events

Treatment

1. See Hypercalcemia

Disposition

1. Ca <12
   1. Home with f/u if oncology concurs
2. Ca>12
   1. Admit ward
3. ECG changes
   1. Admit telemetry

See Also

• Hypercalcemia

Source

• EM Practice 3/10
• Tintinalli