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22 Cards in this Set

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Hypercalcemia:

Normal Calcium Levels
8.5mg/dL - 10.5mg/dL
Hypercalcemia:

Common in What Dx:
TB
Renal
Pagets
Immobilization
Drugs
Pt's on TPN
Hypercalcemia:

Correction required b/c
Hypoalbuminemia

Albumin < 3.0 gm/dL
Hypercalcemia:

Correction Formula
Add 0.8mg/dL to total Ca level

For every 1g/dL serum albumin below 3.5g/dL
Hypercalcemia:

Parathyroid control?

(Parathyroid hormone related peptide)
Stimulates osteoclastic destruction of bone and increased Ca levels.
Hypercalcemia:

Causes
Ovarian Cancer
Breast Cancer
Lung Cancer
Renal Cell Cancer
Lymphoma
Hypercalcemia: Signs & Symptoms

Renal
Frequency

Intracellular volume depletion
Hypercalcemia: Signs & Symptoms

Gastrointestinal
N/V
Constipation
Hypercalcemia: Signs & Symptoms

Cardiovascular
Atrial / Ventricular ARRYTHMIAS

Shortening QT interval
Hypercalcemia: Signs & Symptoms

Neurologic
Lethargy
Confusion
Seziure, Coma, Death
Hypercalcemia: Management

IV Fluids
200 - 300 ml/hr Normal Saline
(NaCl 0.9%)

Decr. 0.5 - 2.0mg/dL max effect 24-48hr

May incr. Ca. excretion
Dilutional effect

Watch K & Mg.
Hypercalcemia: Management

Furosemide
40 - 100mg IV q 1-4 hr after proper hydration
Hypercalcemia: Management

DC offending drugs
Thyazide diuretics
Antacids
Estrogen
Hypercalcemia: Management

Calcitonin
Inhibition of Osteoclast bone resorption

Rapid onset with analgesic prop.

Reduce Ca 1-3mg/dL within 6-8hr

Tachyphylaxis occurs, diminishing effect.
Hypercalcemia: Management

Calcitonin usefull for?
Pt.s unresonsive or C/I to Bisphosphonates

Acute, severe mgmt hypercalcemia
Hypercalcemia: Bisphosphonates

Effect?
Reduce Ca levels 3-4mg/dl effect in 24-72 hrs

Max effect 4 to 9 days
Hypercalcemia: Bisphosphonates

Side Effects:
Hypotension
Renal damage
GI upset
Hypercalcemia: Bisphosphonates

Dosage: Pamidronate (Aredia)
60mg IV over 4 hrs

90mg IV over 24 hrs

May repeat in 7 days
Hypercalcemia: Bisphosphonates

Dosage: Zolendronate (Zometa)
4mg IV over 15 min

May repeat in 7 days
Hypercalcemia: Calcitonin

Dosage
4-8 U /kg SQ q8-12h x 48 hours

Tachyphylaxis
Hypercalcemia: Bisphosphonates

Effect?
Reduce Ca levels 3-4mg/dl effect in 24-72 hrs

Max effect 4 to 9 days

Useful at decreasing bone fracture rates in women with breast cancer and bone mets
Hypercalcemia: Bisphosphonates

Side Effects:
Hypotension
Renal damage
GI upset