Treatment Reminders in Severe Hypercalcemia
- Promote Ca diuresis
(a) I.V. isotonic saline
(b) I.V. frusemide.
Note: Maintain positive NA and water balance.
- Remove / modify causes of hypercalcemia: -
- drug / diet causes
- Corticosteroid therapy in vitamin D intoxication / sarcoidosis
- (a) surgery if feasible
- (b) 60-90 mg pamidronate I.V. over 4-24 hours following saline rehydration normalizes serum Ca within 5 days in 60-100% of cases.
- effect persists for 10-13 days (Nussbaum et al, 1993).
Primary HPT : -
- parathyroidectomy if urgently needed
- patients considered unfit for surgery may be restored to normocalcemia with oral cinacalcet hydrochloride, a calcimimetic agent which increases the sensitivity of parathyroid calcium-sensing receptors to extracellular calcium, thereby reducing PTH secretion (Peacock,2005). The effect is maintained with long-term treatment, but is expensive.
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(Altered consciousness, nausea / vomiting, short Q-T interval on EKG, or serum Ca > 3.25 mM / L (13 mg / dl):