Hypercalcemia of malignancy
Revision as of 04:27, 25 June 2015 by Rossdonaldson1 (talk | contribs)
Background
Causes
- PTHrP release
- SCC (particularly of the head and neck), breast renal, endometrial cancer
- Local osteolysis
- Associated primarily with bone mets
- Multiple myeloma, lung, breast cancer
- Production of vitamin D analogues
- Lymphoma (Hodgkin)
Clinical Features
- See Hypercalcemia
Differential Diagnosis
Causes of Hypercalcemia
- Addison's disease
- Calciphylaxis
- Excess vitamin D
- Hypercalcemia of malignancy
- Hyperparathyroidism
- Hyperthyroidism
- Hypothyroidism
- Lithium
- Milk-alkali syndrome
- Paget disease
- Sarcoidosis
- Thiazide diuretics
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
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
Diagnosis
- Chem10
- Ionized Ca
- CBC
- LFTs (alk phos, albumin)
- ECG
Treatment
- See Hypercalcemia
Disposition
- Ca <12
- Home with f/u if oncology concurs
- Ca>12
- Admit ward
- ECG changes
- Admit telemetry