Hypercalcemia of malignancy
From IDWiki
Mechanisms
- PTHrP secretion (humoral hypercalcemia)
- Squamous cell carcinoma, renal carcinoma, bladder carcinoma, breast carcinoma, ovarian carcinoma, prostate carcinoma, colorectal carcinoma, Non-Hidgkin lymphoma, CML, leukemia, lymphoma
- Osteolytic metastases
- Breat carcinoma, multiple myeloma, lymphoma, leukemia
- 1,25-dihydroxyvitamin D production
- Lymphoma (most common), ovarian dysgerminoma
- Ectopic PTH secretion
- Ovarian carcinoma, lung carcinoma, neuroextodermal, thyroid papillary carcinoma, rhabdomyosarcoma, pancreatic carcinoma
Clinical Manifestations
- Signs and symptoms of hypercalcemia (bones, moans, groans, overtones)
- Volume depleted
- Altered mental status
- Constipation
Management
- Indications for treatment:
- Calcium >3.5 is dangerous!
- Symptoms of hypercalcemia, especially if in the 3 to 3.5 range
- IV fluids 200 to 300 mL/h initially
- Salmon calcitonin 4 u/kg
- Continue every 6 to 12 hours if calcium responds
- Zoledronic acid 4mg IV over 15 minutes or pamidronate 60 to 90 mg IV over 2 hours
