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Discussion Starter · #1 ·
best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
 

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best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
for asymptomatic hyperCAl in sarcoid use steroids not saline .......thats what i read in uw i guess .......:notsure:
 

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best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
Well, from my understanding asyptomatic sarcoid pt. generally need no treatment but if the case is syptomatic for hypercalcemia u ll treat it with I.V. saline and prednisone at the same time.
 

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Discussion Starter · #4 ·
Well, from my understanding asyptomatic sarcoid pt. generally need no treatment but if the case is syptomatic for hypercalcemia u ll treat it with I.V. saline and prednisone at the same time.
can we have any source ? i cant find this info :rolleyes:
 

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best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
Calcium metabolism is dysregulated in active sarcoidosis. This may result in hypercalciuria, hypercalcemia, and nephrolithiasis that may lead to renal insufficiency.28 The primary abnormality in calcium metabolism relates to an increase 1-α hydroxylase activity in sarcoid alveolar macrophages that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, the active form of the vitamin.29

The treatment of hypercalcemia includes the following:
(1) maintenance of an expanded intravascular volume;
(2) reduction of oral calcium supplements, dietary calcium, and vitamin D;
(3) reduction of the inappropriate production of 1,25-dihydroxyvitamin D by sarcoid macrophages and granulomas; and
(4) reduction of 1,25-dihydroxyvitamin D-induced intestinal calcium absorption and bone resorption.

Mild hypercalcemia can be treated initially with the first two approaches:
increased fluid intake and restriction of dietary calcium. The patient should be advised to curtail intake of major sources of dietary calcium and vitamin D, avoid sunlight, and drink a large amount of fluids.

If the serum calcium level is >11 mg/dL, the serum creatinine is elevated, or the patient has nephrolithiasis, pharmacotherapy is usually required.


The drugs of choice are corticosteroids at an initial daily dose of 20 to 40 mg/d of prednisone equivalent. Corticosteroids should be rapidly effective, and failure of the serum calcium to normalize on this regimen in 2 weeks should alert the clinician to an alternate or coexisting disorder, such as hyperparathyroidism, lymphoma, carcinoma, or myeloma. Once the calcium disorder is brought under control, the corticosteroid dose can be lowered over the following 4 to 6 weeks.30 If the patient develops intolerable corticosteroid side effects or fails to respond, chloroquine,31 hydroxychloroquine,32 and ketoconazole33 have been used successfully.

Ref ACCP

http://www.chestnet.org/accp/pccsu/treatment-sarcoidosis?page=0,3
 
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