- Bone pain,
- Fractures (occur when calcium leaves the bone due to cancer, osteoporo-
sis, and other disorders), - Kidney stones,
- Hypertension,
- Cardiac arrhythmias,
- Coma.
Treatment is based on the calcium level. The calcium level may need to be
lowered quickly because severe hypercalcemia can be life threatening.
Treat the underlying cause if known.- If kidney function is adequate:
° Administer isotonic saline IV to hydrate the patient.
° Make sure the patient drinks 3000 to 4000 ml of fluid to excrete the cal-
cium in urine.
° Administer furosemide (Lasix) or ethcrynic acid (Edecrin) loop diuret-
ics after adequate fluid intake is established. - Administer synthetic calcitonin to lower serum calcium concentration
- Administer plicamycin (Mithracin) to increase absorption of calcium in bone.
- Provide a low-calcium diet.
- Make sure the patient performs weight-bearing activities.
- Take safety measure to protect the patient who experiences neuromuscular
effects.
Hemodialysis is the most effective method to lower calcium levels in severe
cases when kidney function is not normal.Hypocalcemia
Hypocalcemia occurs when the serum calcium level is lower than 8.5 mg/dL
indicating there is a lower than normal concentration of calcium. This usually
produces a high serum phosphorus level. Too little calcium intake causes cal-
cium to leave the bone to maintain a normal calcium level. Fractures (broken
bones) may occur if a calcium deficit persists because of calcium loss from the
bones (demineralization).
Hypocalcemia is caused by:- Hypoparathyroidism.
- Thyroid or neck surgery where the parathyroid gland is removed or injured.
(^174) CHAPTER 10 Fluid and Electrolyte Therapy