Template:Hypercalcemia treatment - Revision history

Dcpinzonc: /* Bisphosphonates */

2022-08-25T14:14:10Z

Bisphosphonates

← Revisión anterior		Revisión del 14:14 25 ago 2022
Línea 17:		Línea 17:

	====Bisphosphonates====		====Bisphosphonates====
	Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)[≥12 mg/dL][≥3 mmol/L]<ref>uptodate</ref>		Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)[≥12 mg/dL][≥3 mmol/L]<ref>Shane et al. Uptodate: Treatment of Hypercalcemia. https://www.uptodate.com/contents/treatment-of-hypercalcemia#disclaimerContent</ref>
	*Pamidronate 90mg IV over 24 hours OR		*Pamidronate 90mg IV over 24 hours OR
	*[[Zoledronate]] 4mg IV over 15 minutes		*[[Zoledronate]] 4mg IV over 15 minutes

Dcpinzonc: /* Bisphosphonates */

2022-08-25T14:06:01Z

Bisphosphonates

← Revisión anterior		Revisión del 14:06 25 ago 2022
Línea 17:		Línea 17:

	====Bisphosphonates====		====Bisphosphonates====
	Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)		Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)[≥12 mg/dL][≥3 mmol/L]<ref>uptodate</ref>
	*Pamidronate 90mg IV over 24 hours OR		*Pamidronate 90mg IV over 24 hours OR
	*[[Zoledronate]] 4mg IV over 15 minutes		*[[Zoledronate]] 4mg IV over 15 minutes

Pjcalcagni: /* Dialysis */

2021-11-01T20:44:15Z

Dialysis

← Revisión anterior		Revisión del 20:44 1 nov 2021
Línea 37:		Línea 37:
	*Serum Calcium level >18mg/dL		*Serum Calcium level >18mg/dL
	*Neurologic symptoms		*Neurologic symptoms
			*Heart failure with reduced ejection fraction (unable to provide fluids)

	====[[Corticosteroids]]====		====[[Corticosteroids]]====
	''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''		''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''
	*[[Prednisone]] 60mg PO daily		*[[Prednisone]] 60mg PO daily

Shihabali: /* Dialysis */

2019-11-28T03:36:03Z

Dialysis

← Revisión anterior		Revisión del 03:36 28 nov 2019
Línea 36:		Línea 36:
	*Severe [[fluid overload\|hypervolemia]] not amenable to diuresis		*Severe [[fluid overload\|hypervolemia]] not amenable to diuresis
	*Serum Calcium level >18mg/dL		*Serum Calcium level >18mg/dL
			*Neurologic symptoms

	====[[Corticosteroids]]====		====[[Corticosteroids]]====
	''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''		''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''
	*[[Prednisone]] 60mg PO daily		*[[Prednisone]] 60mg PO daily

ClaireLewis at 16:52, 16 October 2019

2019-10-16T16:52:01Z

← Revisión anterior		Revisión del 16:52 16 oct 2019
Línea 34:		Línea 34:
	*Anuric with [[renal failure]]		*Anuric with [[renal failure]]
	*Failing all other therapy		*Failing all other therapy
	*Severe [[~~volume~~ overload\|hypervolemia]] not amenable to diuresis		*Severe [[fluid overload\|hypervolemia]] not amenable to diuresis
	*Serum Calcium level >18mg/dL		*Serum Calcium level >18mg/dL

ClaireLewis at 00:58, 29 September 2019

2019-09-29T00:58:07Z

← Revisión anterior		Revisión del 00:58 29 sep 2019
Línea 7:		Línea 7:

	===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===		===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===
	*Patients are likely dehydrated and require saline hydration as initial therapy		*Patients are likely dehydrated and require [[normal saline\|saline]] hydration as initial therapy

	====Hydration====		====Hydration====
	*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour		*Isotonic [[normal saline\|saline]] at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour

	====[[Calcitonin]]====		====[[Calcitonin]]====

ClaireLewis at 00:57, 29 September 2019

2019-09-29T00:57:30Z

← Revisión anterior		Revisión del 00:57 29 sep 2019
Línea 22:		Línea 22:
	*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>		*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>

	====Electrolyte Repletion====		====[[electrolyte repletion\|Electrolyte Repletion]]====
	*Correct [[hypokalemia]]		*Correct [[hypokalemia]]
	*Correct [[hypomagnesemia]]		*Correct [[hypomagnesemia]]

	====Diuresis====		====[[diuretics\|Diuresis]]====
	*[[Furosemide]] is NOT routinely recommended		*[[Furosemide]] is NOT routinely recommended
	*Only consider in patients with renal insufficiency or heart failure and volume overload		*Only consider in patients with renal insufficiency or heart failure and volume overload

	====Dialysis====		====[[Dialysis]]====
	Consider if patient:		Consider if patient:
	*Anuric with ~~Renal Failure~~		*Anuric with [[renal failure]]
	*Failing all other therapy		*Failing all other therapy
	*Severe hypervolemia not amenable to diuresis		*Severe [[volume overload\|hypervolemia]] not amenable to diuresis
	*Serum Calcium level >18mg/dL		*Serum Calcium level >18mg/dL

ClaireLewis at 16:52, 25 August 2019

2019-08-25T16:52:00Z

← Revisión anterior		Revisión del 16:52 25 ago 2019
Línea 7:		Línea 7:

	===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===		===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===
	*~~Pts~~ are likely dehydrated and require saline hydration as initial therapy		*Patients are likely dehydrated and require saline hydration as initial therapy

	====Hydration====		====Hydration====
	*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour		*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour

	====Calcitonin====		====[[Calcitonin]]====
	*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)		*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
	*Tachyphylaxis limits use long term, but is a great choice for emergent cases		*Tachyphylaxis limits use long term, but is a great choice for emergent cases
Línea 19:		Línea 19:
	Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)		Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)
	*Pamidronate 90mg IV over 24 hours OR		*Pamidronate 90mg IV over 24 hours OR
	*Zoledronate 4mg IV over 15 minutes		*[[Zoledronate]] 4mg IV over 15 minutes
	*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>		*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>

Rossdonaldson1 at 18:42, 16 December 2015

2015-12-16T18:42:39Z

← Revisión anterior		Revisión del 18:42 16 dic 2015
Línea 2:		Línea 2:
	*Does not require immediate treatment		*Does not require immediate treatment
	*Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)		*Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)

	===Mildly symptomatic Ca 12-14 mg/dL===		===Mildly symptomatic Ca 12-14 mg/dL===
	*May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)		*May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)

	===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===		===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===
	*Pts are likely dehydrated and require saline hydration as initial therapy		*Pts are likely dehydrated and require saline hydration as initial therapy

	====Hydration====		====Hydration====
	*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour		*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour

	====Calcitonin====		====Calcitonin====
	*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)		*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
Línea 21:		Línea 25:
	*Correct [[hypokalemia]]		*Correct [[hypokalemia]]
	*Correct [[hypomagnesemia]]		*Correct [[hypomagnesemia]]

	====Diuresis====		====Diuresis====
	*Furosemide is NOT routinely recommended		*[[Furosemide]] is NOT routinely recommended
	*Only consider in patients with renal insufficiency or heart failure and volume overload		*Only consider in patients with renal insufficiency or heart failure and volume overload

	====Dialysis====		====Dialysis====
	Consider if patient:		Consider if patient:
Línea 30:		Línea 36:
	*Severe hypervolemia not amenable to diuresis		*Severe hypervolemia not amenable to diuresis
	*Serum Calcium level >18mg/dL		*Serum Calcium level >18mg/dL
	====Corticosteroids====
	Decrease Ca mobilization from bone and are helpful w/ steroid-sensitive tumors (e.g. lymphoma, MM)		====[[Corticosteroids]]====
	*Prednisone 60mg PO daily		''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''
			*[[Prednisone]] 60mg PO daily

Rossdonaldson1: Created page with "===Asymptomatic or Ca <12 mg/dL=== Does not require immediate treatment Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, p..."

2015-12-16T18:41:48Z

Created page with "===Asymptomatic or Ca <12 mg/dL=== *Does not require immediate treatment *Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, p..."

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===Asymptomatic or Ca <12 mg/dL===
*Does not require immediate treatment
*Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)
===Mildly symptomatic Ca 12-14 mg/dL===
*May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)
===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===
*Pts are likely dehydrated and require saline hydration as initial therapy
====Hydration====
*Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour
====Calcitonin====
*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
*Tachyphylaxis limits use long term, but is a great choice for emergent cases

====Bisphosphonates====
Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)
*Pamidronate 90mg IV over 24 hours OR
*Zoledronate 4mg IV over 15 minutes
*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>

====Electrolyte Repletion====
*Correct [[hypokalemia]]
*Correct [[hypomagnesemia]]
====Diuresis====
*Furosemide is NOT routinely recommended
*Only consider in patients with renal insufficiency or heart failure and volume overload
====Dialysis====
Consider if patient:
*Anuric with Renal Failure
*Failing all other therapy
*Severe hypervolemia not amenable to diuresis
*Serum Calcium level >18mg/dL
====Corticosteroids====
Decrease Ca mobilization from bone and are helpful w/ steroid-sensitive tumors (e.g. lymphoma, MM)
*Prednisone 60mg PO daily

Template:Hypercalcemia treatment - Revision history

Dcpinzonc: /* Bisphosphonates */

Dcpinzonc: /* Bisphosphonates */

Pjcalcagni: /* Dialysis */

Shihabali: /* Dialysis */

ClaireLewis at 16:52, 16 October 2019

ClaireLewis at 00:58, 29 September 2019

ClaireLewis at 00:57, 29 September 2019

ClaireLewis at 16:52, 25 August 2019

Rossdonaldson1 at 18:42, 16 December 2015

Rossdonaldson1: Created page with "===Asymptomatic or Ca <12 mg/dL=== *Does not require immediate treatment *Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, p..."

Rossdonaldson1: Created page with "===Asymptomatic or Ca <12 mg/dL=== Does not require immediate treatment Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, p..."