Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypercalcemia 741

General Measures

■IV Pamidronate 60 to 90 mg or Zoledronic acid 4 mg IV repeated

every 2–4 wks

■Calcitonin (IM or SQ) 4–8 IU/kg q 12

specific therapy

■Primary HPTH – consider parathyroidectomy

■Cancer – treat underlying tumor (radiation, surgery, chemotherapy)

■Vitamin D toxicity, granulomatous disease, myeloma – 40 to 60 mg

prednisone /day

■FBH – avoid surgical referral

■Thyrotoxicosis- antithyroid drugs, beta blockers, 131I ablation

Side-Effects & Complications

■Pamidronate or zoledronic acid – leukopenia; small percentage of

patients – flu-like syndrome (fever, arthralgias myalgias); rare com-

plication – jaw necrosis

■Calcitonin – itching, rash, nausea, vomiting, dizziness

Contraindications

■Absolute

➣Pamidronate or zoledronic acid – renal failure, creat >2.5 mg/dl

➣Calcitonin – allergy to salmon

■Relative

➣Active periodontal disease

follow-up

■Slow response to pamidronate or zoledronic acid (3 to 7 days) may

persist 4 to 6 weeks before need to re-treat

■More rapid response to calcitonin (1 to 2 days), tachyphylaxis com-

mon with prolonged administration

■Gradual response to steroids

complications and prognosis

■General: renal failure, dehydration, hypotension, vascular collapse,

delirium, stupor, coma, death

■Primary HPTH: stones, renal insufficiency, fractures, psychiatric dis-

turbances, depression

■Cancer: unremitting hypercalcemia, bone pain, pathologic fractures,

cachexia, death

■Glucocorticoids: glucose intolerance, osteoporosis, infection