Emerging topics in pediatric bone and mineral disorders Acute treatment of hypercalcemia with furosemide. For patients with severe, symptomatic hypercalcemia of malignancy that is refractory to ZA, denosumab initial dose 60 mg subcutaneously, with repeat dosing based upon response is an alternative option. As a result, IV clodronate is often preferred at the onset of therapy [ 43 ], with oral clodronate being used for maintenance therapy. Get helpful advice on your cases from a community of physicians.
Subsequent trials showed that shorter infusion times two to four hours were safe and effective, maintaining normocalcemia for two or more weeks [ 22,34 ]. Serum calcium concentrations begin to decrease in one or two days. Alexion [Hypophosphatasia Recombinant alkaline phosphatase ].
ZA is available in many countries for treatment of hypercalcemia of malignancy at a dose of 4 mg IV over at least 15 minutes. Literature review current through: Although bisphosphonates are most commonly used to treat established hypercalcemia, they have also been given to prevent hypercalcemia and adverse skeletal events, particularly in patients with metastatic cancer to bone.
In addition, the median duration of serum calcium control was longer for those receiving ZA 32 to 43 versus 18 days. Gain Essential Business Knowledge. Hypovolemia exacerbates hypercalcemia by impairing the renal clearance of calcium table 1 [ 6 ]. Want to share your unique perspective on hot topics in HM? See 'Moderate hypercalcemia' above. The frequency of response was significantly higher with 4 or 6 mg than with 2 mg 76 to 77 versus 50 percentbut the duration of response was not dose dependent [ 41 ].
Practice Management Quick Byte: Additional therapy depends mostly upon the cause of the hypercalcemia. However, the optimal dose of denosumab in the setting of renal impairment is uncertain.
Hypercalcemia caused by parent vitamin D or calcidiol lasts longer, so that more aggressive therapy such as glucocorticoids and ZA or pamidronate may be necessary [ 5 ].
If a laboratory known to measure ionized calcium reliably is available, some authorities prefer to measure the serum ionized calcium in this situation. Severe hypercalcemia mimicking ST-segment elevation myocardial infarction. He was started on aggressive IV hydration with normal saline and zoledronic acid. Isotonic saline corrects possible volume depletion due to hypercalcemia-induced urinary salt wasting and, in some cases, vomiting.
Calcitonin is safe and relatively nontoxic other than mild nausea and the rare hypersensitivity reaction. Share cases and questions with Physicians on Medscape consult.
Fast 4-h or slow h infusions of pamidronate disodium aminohydroxypropylidene diphosphonate APD as single shot treatment of hypercalcaemia. Lost in transmission--FDA drug information that never reaches clinicians.