University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

382

Pages:

2
Author:

Mariam A.

Treatment of Hypercalcemia Overview: Hypercalcemia, characterized by elevated serum calcium levels, can result from primary hyperparathyroidism, malignancy, excessive vitamin D intake, and certain medications. Severe hypercalcemia is a medical emergency and can lead to nephrocalcinosis, renal failure, and cardiac arrhythmias. Acute Hypercalcemia:   Presentation: Symptoms include polyuria, polydipsia, dehydration, nausea, vomiting, constipation, confusion, and cardiac arrhythmias. Management: o Hydration: Aggressive intravenous hydration with isotonic saline to enhance renal calcium excretion. Typically, 4-6 liters are administered over 24 hours, adjusting the rate based on the patient’s volume status and renal function. o Diuretics: Loop diuretics like furosemide may be used after adequate hydration to further promote calcium excretion. Thiazide diuretics are contraindicated as they can increase serum calcium levels. o Bisphosphonates: Intravenous bisphosphonates (e.g., pamidronate, zoledronic acid) inhibit bone resorption and are effective in malignancy-associated hypercalcemia. Effects begin within 48 hours, with maximum response in 4-7 days. o Calcitonin: Calcitonin can be used for rapid, short-term reduction of calcium levels. It acts within hours, but its effect is transient, often necessitating concurrent use of bisphosphonates. o Glucocorticoids: Effective in hypercalcemia due to vitamin D toxicity or certain malignancies (e.g., lymphoma). They decrease intestinal calcium absorption and increase renal excretion. o Dialysis: Hemodialysis may be required for patients with severe hypercalcemia unresponsive to other treatments, particularly in those with renal failure. Chronic Hypercalcemia:   Etiology: Often due to primary hyperparathyroidism or malignancy. Management: o Address Underlying Cause: Surgical removal of parathyroid adenoma in primary hyperparathyroidism or treatment of malignancy. o Medications: Long-term management with bisphosphonates, calcimimetics (e.g., cinacalcet for primary hyperparathyroidism), and hydration. o Diet and Lifestyle: Encourage patients to maintain hydration and avoid excessive calcium and vitamin D intake. o Monitoring: Regular monitoring of serum calcium, renal function, and bone density to adjust therapy and prevent complications. Crisis Situations: Hypercalcemic Crisis:   Presentation: Severe hypercalcemia (>14 mg/dL) with dehydration, altered mental status, and organ dysfunction. Management: Aggressive IV hydration, bisphosphonates, calcitonin, and dialysis if needed. Continuous cardiac monitoring and intensive care support are crucial. Hypocalcemic Crisis:   Presentation: Severe hypocalcemia (<7.5 mg/dL) with tetany, seizures, laryngospasm, and cardiac arrhythmias. Management: Rapid IV calcium administration, continuous cardiac monitoring, and addressing underlying causes. Frequent reassessment and adjustment of therapy are necessary.