Hypercalcemia
Terms
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Hypercalcemia:
Normal Calcium Levels - 8.5mg/dL - 10.5mg/dL
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Hypercalcemia:
Common in What Dx: -
TB
Renal
Pagets
Immobilization
Drugs
Pt's on TPN -
Hypercalcemia:
Correction required b/c -
Hypoalbuminemia
Albumin < 3.0 gm/dL -
Hypercalcemia:
Correction Formula -
Add 0.8mg/dL to total Ca level
For every 1g/dL serum albumin below 3.5g/dL -
Hypercalcemia:
Parathyroid control?
(Parathyroid hormone related peptide) - Stimulates osteoclastic destruction of bone and increased Ca levels.
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Hypercalcemia:
Causes -
Ovarian Cancer
Breast Cancer
Lung Cancer
Renal Cell Cancer
Lymphoma -
Hypercalcemia: Signs & Symptoms
Renal -
Frequency
Intracellular volume depletion -
Hypercalcemia: Signs & Symptoms
Gastrointestinal -
N/V
Constipation -
Hypercalcemia: Signs & Symptoms
Cardiovascular -
Atrial / Ventricular ARRYTHMIAS
Shortening QT interval -
Hypercalcemia: Signs & Symptoms
Neurologic -
Lethargy
Confusion
Seziure, Coma, Death -
Hypercalcemia: Management
IV Fluids -
200 - 300 ml/hr Normal Saline
(NaCl 0.9%)
Decr. 0.5 - 2.0mg/dL max effect 24-48hr
May incr. Ca. excretion
Dilutional effect
Watch K & Mg. -
Hypercalcemia: Management
Furosemide - 40 - 100mg IV q 1-4 hr after proper hydration
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Hypercalcemia: Management
DC offending drugs -
Thyazide diuretics
Antacids
Estrogen -
Hypercalcemia: Management
Calcitonin -
Inhibition of Osteoclast bone resorption
Rapid onset with analgesic prop.
Reduce Ca 1-3mg/dL within 6-8hr
Tachyphylaxis occurs, diminishing effect. -
Hypercalcemia: Management
Calcitonin usefull for? -
Pt.s unresonsive or C/I to Bisphosphonates
Acute, severe mgmt hypercalcemia -
Hypercalcemia: Bisphosphonates
Effect? -
Reduce Ca levels 3-4mg/dl effect in 24-72 hrs
Max effect 4 to 9 days
Useful at decreasing bone fracture rates in women with breast cancer and bone mets -
Hypercalcemia: Bisphosphonates
Side Effects: -
Hypotension
Renal damage
GI upset -
Hypercalcemia: Bisphosphonates
Dosage: Pamidronate (Aredia) -
60mg IV over 4 hrs
90mg IV over 24 hrs
May repeat in 7 days -
Hypercalcemia: Bisphosphonates
Dosage: Zolendronate (Zometa) -
4mg IV over 15 min
May repeat in 7 days -
Hypercalcemia: Calcitonin
Dosage -
4-8 U /kg SQ q8-12h x 48 hours
Tachyphylaxis