HYPERCALCEMIA
Definition:
An increase in total plasma calcium concentration > 10.5
mg/dL
Etiology:
Primary hyperparathyroidism
Malignancy-associated hypercalcemia.
Symptoms and Signs
Symptoms of hypercalcemia irrespective of cause are
constipation and polyuria.
A variety of neurologic symptoms also are observed.
Stupor, coma, and azotemia may develop in severe
hypercalcemia.
Ventricular extrasystoles and idioventricular rhythm occur
and can be accentuated by digitalis.
Laboratory Findings
The highest serum calcium levels (> 15 mg/dL) generally
occur in malignancy
The ECG shows a shortened QT interval.
Measurements of PTH and PTH-related protein (PTHrP)
help distinguish between hyperparathyroidism (elevated
PTH) and malignancy-associated hypercalcemia (elevated
PTHrP)
Treatment
Saline and furosemide:
Until the primary disease can be brought under control,
renal excretion of calcium with resultant decrease in
serum calcium concentration is promoted.
Excretion of Na+ is accompanied by excretion of Ca2+.
Establishing euvolemia and inducing natriuresis by giving
saline with furosemide is the emergency treatment of
choice.
In dehydrated patients with normal cardiac and renal
function, 0.45% saline or 0.9% saline can be given rapidly
(250-500 mL/h)
Intravenous furosemide (20-40 mg every 2 hours)
prevents volume overload and enhances Ca2+ excretion.
In the treatment of hypercalcemia of malignancy,
bisphosphonates are safe and effective in more than 95%
of patients and are the mainstay of treatment.
In emergency cases, dialysis with low or no calcium
dialysate may be needed
IV phosphates:
A more hazardous approach to treatment is the IV
administration of disodium and monopotassium
phosphate.
No more than 0.5 to 1.0 g should be given IV in 24 h;
usually 1 or 2 doses over 2 days are sufficient to lower
plasma Ca for 10 to 15 days.
IV PO4 should be used only when hypercalcemia is life
threatening and unresponsive to other methods and when
short-term hemodialysis is not possible
NB: Treatment: hydration, fursemide, mithrodycin, calcitonin
