Emergencies >> Hypercalcemia

Background:

Hypercalcemia is often caused by bone metastases of lung cancer, renal cancer, breast cancer, prostate cancer, and multiple myeloma.  It can also be caused by a paraneoplastic syndrome (e. g. small cell lung cancer).

Symptoms:

Fatigue, lethargy, psychiatric symptoms, nausea, constipation, polyuria, polydypsia.

 

Therapy:

• Consider dialysis!
• Administration of fluids and diuretics (if renal function is normal, e. g.: 3x 1000 ml NaCl 0,9% / D5% + 2x 40 mg lasix per day)
• Bisphosphonates, e. g.. zoledronate (Zometa®/Reclast®) 4 mg over 15 min. i. v. (or pamidronate (Aredia®) 90 mg over 90 min. i. v.
• Steroids (may lower calcium absorption), e. g. 3x 8 mg dexamethasone
• If a quick decrease of calcium is needed, consider calcitonin i. v.
• Monitor calcium regularly. Attention: Some machines measure the "free calcium". This may suggest lower calcium values than total calcium measurement.