Oncologic Emergencies: Hypercalcemia of Malignancy Flashcards
Mild hypercalcemia (corrected)
10.5-11.9mg/dl
Moderate hypercalcemia (corrected)
12-13.9mg/dl
Severe hypercalcemia (corrected)
≥14mg/dl
Hypercalcemia symptoms: renal
polyuria, polydipsia, dehydration, decreased GFR
Hypercalcemia symptoms: GI
constipation, anorexia, N/V, acute pancreatitis (rare)
Hypercalcemia symptoms: neurologic
lethargy, confusion, irritability, muscle weakness, seizure, stupor, coma
Hypercalcemia symptoms: cardiac
shortened QT interval, widened T-wave, heart block, asystole, atrial and ventricular arrhythmia
Goal of hypercalcemia of malignancy treatment
Treat underlying malignancy
What kinds of medications do you hold that can worsen hypercalcemia
Vitamin D, calcium, thiazide diuretics
Hypercalcemia of malignancy treatments
Hydration: NS +/- furosemide
Primary therapy: IV bisphosphonates, RANK-L inhibitors
IV bisphosphonates used
Zoledronic acid, pamidronate
Onset of IV bisphosphonates
48-72 hours, nadir in 4-7 days
AEs of bisphosphonates
flu-like symptoms (premeditate with APAP), fever, arthralgias, nephrotoxicity, osteonecrosis of the jaw
RANK-L inhibitor
Denosumab
Denosumab onset
48-72 hours, nadir in 9-10 days
Denosumab role in hypercalcemia of malignancy therapy
hypercalcemia refractory to bisphosphonates; use in patients with severe renal impairment
Denosumab toxicity
Severe hypocalcemia, hypophosphatemia
Secondary therapy for hypercalcemia of malignancy
Calcitonin, glucocorticoids, calcimimetics, dialysis
Calcitonin onset
1-4 hours, peak in 12-24 hours
Calcitonin counseling point
Limited to first 48 hours due to tachyphylaxis
Glucocorticoid clinical pearl
Multiple myeloma is susceptible to steroids
What are calcimimetics effective in?
parathyroid carcinoma or primary/secondary hyperparathyroidism
