Hypercalcemia

Question 1

What are the adverse effects associated with hypercalcemia?

Answer 1

● Renal damage
● cardiac arrhythmias
● soft tissue calcification
● CNS abnormalities
● Nausea / vomiting = warning sign

Question 2

What are the treatments for hypercalcemia?

Answer 2

Saline Diuresis
● Rehydration
● Furosemide diuresis (not thiazide)
● Hypercalcemia can be life threatening . Rehydration with IV isotonic saline since patients are frequently severely dehydrated b/c hypercalcemia compromises renal concentrating mechanisms. Agents that augment Ca2 + excretion such as loop ( not thiazide) diuretics may help to counteract the effect of plasma volume expansion by saline, but are contradicted until volume is repleted b/c otherwise they will aggravate volume depletion.

Calcitonin - See above

Mithramycin - See above

• A cytotoxic antibiotic that reduces bone resorption by impairing osteoclast function; binds to DNA and inhibits formation of mRNA: protein synthesis may be required for bone resorption by osteoclasts
• Used to treat hypercalcemia and Paget’s disease at 1/10 the dose used to treat cancer
• Mitramycin also has chelating activity

Phosphate - Bind Ca and form complex (b/c only free Ca can do damage)

• Kind of a last ditch effort
• Danger is the development of sudden hypocalcemia

Glucocorticoids - No real role, unless hypercalcemia results from sarcoidosis, lymphoma, or hypervitaminosis D

Bisphosphonates - IV bisphosphonates have proven to be very effective in the management of hypercalcemia