Hypercalcemia

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 Hypercalcemia
Elevation of calcium level in the blood.

Immediate Questions:

F.Vital signs?
G.Mental status?
B. Underlying condition(s)?
 Potential etiologies

1. Malignancy: bone mets, ectopic

PTH, osteoclast activating factor
2. Primary hyperparathyroidism
3. Myeloma
4. Vitamin D excess
 Potential etiologies
5. Sarcoid / granulomatous disease
6. Milk alkali
7. Other: hyperthyroidism, thiazide
diuretics, lithium, immobilization
(especially children)
 Differential Diagnosis

Among outpatients, malignancy and

primary hyperparathyroidism are
leading diagnoses. Malignancy
predominates as an etiology for
hypercalcemia among hospitalized
individuals.
 Therapy
Patients usually are profoundly volume
depleted and can require several liters
of NS volume replacement. Volume
replacement is the initial step in
management. Lasix can be added to
help increase a saline diuresis (>2500
ml urine/day) and calcium excretion
but should only be used following
volume replacement.
_______________________________________
 Agent Dose Comments
Saline + furosemide 40-80 mg IV each
2 hours monitor hourly urine output,
(diuretic only if plus NS equal to urine
monitor electrolytes frequently
adequately hydrated) output
Mithramycin 25 mcg/kg IV every
response takes 24 hours; can 2-3 days
cause bone marrow suppression
 Agent Dose Comments
Pamidronate 60-80 mg IV over 6 to
response in 3 to 4 days, which
(mainstay of therapy) 24 hours lasts
up to 7 to 14 days
Prednisone 40-60 mg per day
antagonize actions vitamin D;
decreases calcium absorption and
increases calcium excretion; in most
cases, effect lasts only for a few days