Hypercalcemia: Difference between revisions

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*High! >12.0 meq/L
*High! >12.0 meq/L
*90% of cases a/w malignancy or hyperparathyroidism
*90% of cases a/w malignancy or hyperparathyroidism
*Symptoms most correlated w/ rate of rise of Ca, not absolute level


==Clinical Features==
==Clinical Features==
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==Treatment==
==Treatment==
===Indications===
===Emergency Department===
#>14.0 meq/L
#Volume repletion
#Symptomatic
##Goal UOP = 500cc/hr
#Unable to tolerated PO
##Start NS @ 250-500cc/hr until pt is euvolemic; then decrease to 100-150cc/hr
#Abnormal renal function
#Correct hypokalemia
#Correct hypomagnesemia
#Furosemide is NOT recommended
#Dialysis if:
##Anuric
##ARF
##CHF
##Calcium level >18


===Treatment===
===Inpatient===
#Volume repletion (NS 5-10L)
##Goal UOP = 500cc/hr
#Decrease Ca mobilization from bone
#Decrease Ca mobilization from bone
##Pamidronate 90mg IV over 24 hours
##Calcitonin
##Zoledronic acid 4mg IV over 15 minutes
###4 units/kg SC or IV q12hr
##Calcitonin 4 units/kg SubQ
###Lowers Ca within 2-4hr
#Correct hypokalemia/hypomagnesemia
##Corticosteroids
#Consider dialysis if anuric, ARF or CHF
###Prednisone 60mg PO qd
#Furosemide is NOT recommended
###Helpful w/ steroid-sensitive tmors (e.g. lymphoma, MM)
##Bisphosphonates
###Lowers Ca within 12-48hr
###Pamidronate 90mg IV over 24 hours
##Zoledronate 4mg IV over 15 minutes


==See Also==
==See Also==

Revision as of 01:35, 23 October 2011

Background

  • High >10.5 meq/L (>2.7 ionized)
  • High! >12.0 meq/L
  • 90% of cases a/w malignancy or hyperparathyroidism
  • Symptoms most correlated w/ rate of rise of Ca, not absolute level

Clinical Features

  1. Stones
    1. Renal calculi
  2. Bones
    1. Bone pain/destruction
  3. Groans
    1. Abd pain, N/V, constipation
  4. Moans
    1. Lethargy/confusion
  5. Also:
    1. Polyuria/polydipsia
    2. Dehydration
    3. Renal insufficiency

Diagnosis

  1. ECG
    1. Prolonged PR & QRS
    2. Shortened QT
    3. Depressed ST
    4. Widened T waves
    5. Bradarrhythmias/ heart block


Work-Up

  1. Calcium
  2. Phosphate
  3. Lipase
  4. UA
  5. ECG

DDX

  1. Malignancy
  2. Hyperparathyroidism
  3. Lithium
  4. Thiazides
  5. Hypothyroidism
  6. Addison's
  7. Paget's
  8. Sarcoid
  9. Hyperthyroid
  10. Milk-alkali synd
  11. Excess vit D

Treatment

Emergency Department

  1. Volume repletion
    1. Goal UOP = 500cc/hr
    2. Start NS @ 250-500cc/hr until pt is euvolemic; then decrease to 100-150cc/hr
  2. Correct hypokalemia
  3. Correct hypomagnesemia
  4. Furosemide is NOT recommended
  5. Dialysis if:
    1. Anuric
    2. ARF
    3. CHF
    4. Calcium level >18

Inpatient

  1. Decrease Ca mobilization from bone
    1. Calcitonin
      1. 4 units/kg SC or IV q12hr
      2. Lowers Ca within 2-4hr
    2. Corticosteroids
      1. Prednisone 60mg PO qd
      2. Helpful w/ steroid-sensitive tmors (e.g. lymphoma, MM)
    3. Bisphosphonates
      1. Lowers Ca within 12-48hr
      2. Pamidronate 90mg IV over 24 hours
    4. Zoledronate 4mg IV over 15 minutes

See Also

Hypercalcemia of Malignancy

Source

Tintinalli

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