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Old 07-18-2013
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Help Hypercalcemia & Malignancy

Review books are confusing on this subject, i do not seem to find any clear cut recommendations.
Bony mets following malignancy or Hypercalcemia with malignancy; the options r numerous .
Plz Help & Explain...
When to use what & based on Ca2+ level/symptoms/???
Saline
Saline + loop
Calcitonin
Bisphosphonates
Radiation

The only thing they seem clear about is Steroids immediately if mets causing compression of Spinal Cord & pt. presenting with any neuro sx

Thanx everyone
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Old 07-19-2013
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Saline: you give saline when there is hypercalcemia and the person is having very severe symptoms (immediate tx)

Saline plus loop? Well from what I've studied saline plus a loop is a treatment for mild hyponatremia

Biphosphates: this is given when the person has mild hypercalcemia. For example a patient who has hypercalcemia due to cancer. Usually these people don't really have severe enough symptoms to warrant immediate saline infusions. So these patients receive biphosphates.

Radiation: a person who has prostate cancer, has had an orchitectomy, but is still having back pain, radiation is a good treatment for these patients to relieve the back pain!

Calcitonin: well usually in patients who have osteoporosis you give vit d calcium and biphosphates. Standard treatment are those. But if they are responding slowly and you need immediate help you can give them inhaled calcitonin. But it has a short duration of action that's why they don't use it as a standard of therapy.

Hope I helped and was able to provide some info! If I'm wrong please correct me thanks

Last edited by docmur87; 07-19-2013 at 12:52 AM.
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Old 07-19-2013
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'bisphosphonate therapy & loop diuretics are used for the treatment of symptomatic hypercalcemia'
i'm quoting UW here

remember Loops Loose Ca2+
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Old 07-19-2013
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Quote:
Originally Posted by Cairo View Post
'bisphosphonate therapy & loop diuretics are used for the treatment of symptomatic hypercalcemia'
i'm quoting UW here

remember Loops Loose Ca2+
Oh you said saline plus a loop diuretic lol. Yeah loop diuretics can be used but since they can cause hypercalciuria we usually don't use them as a standard of care. You don't want to end up causing the person to have renal stones lol. But yes that is an option.
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Old 07-19-2013
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According to a Uworld explanation I read a few days back, In severe hypercalcemia try to avoid loop diuretics unless patient has a fluid overload condition like CHF. Do with saline hydration and calcitonin immediately and zolidronate for maintenance if the condition warrants it.
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Old 07-19-2013
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Quote:
Originally Posted by Cairo View Post
Review books are confusing on this subject, i do not seem to find any clear cut recommendations.
Bony mets following malignancy or Hypercalcemia with malignancy; the options r numerous .
Plz Help & Explain...
When to use what & based on Ca2+ level/symptoms/???
Saline
Saline + loop
Calcitonin
Bisphosphonates
Radiation

The only thing they seem clear about is Steroids immediately if mets causing compression of Spinal Cord & pt. presenting with any neuro sx

Thanx everyone
For sever hypercalcemia;dry mucous membranes ,altered mental status,etc : first step >iv normal saline.
Loop diuretics is used only after hydration in very sever cases.
Bisphosphpnates is used in sever cases but take 2-3 days to reach maximum effect so if fluid and diuretics do not lower ca level quickly enough u add calcitonin for the first 2 days till bisphosphonates work.
If wet mucous membranes no change in mental status >bisphosphonates, it inhibits osteoclasts and stimulate osteoblasts so it both decrease serum ca and decrease the risk of pathologic fractures in cases of bone mets.
Radiation is mainly palliative for pain associated with bone mets.
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