Hpercalcemia & its Management

50 %
50 %
Information about Hpercalcemia & its Management

Published on December 16, 2016

Author: DrShadSalimAkhterAkh

Source: slideshare.net

1. Malignant Hypercalcemia • What is it? • What causes it? • Why to treat it? • How to treat it?

2. What Is It? Ca+ + level >10.3mg/dl >2.57mmol/l Total Ionised >5.1mg/dl >1.27mmol/l A symptomatic pt with normal total Ca level

3. • 1% of all ca pts suffer from HiCa • Ca mobilisation exceeds renal threshold • Causes in ambulatory vs. Hospitalised pts • Tumour assoc HiCa caused by osteolysis • 80% with malignant HiCa have bone mets – 80% osteolytic • PTHrP may be produced without bone mets What Causes It?

4. • Breast ca • Bronchogenic ca • Renal cell ca • Multiple Myeloma • Thyroid ca • Sq cell ca H & N, oesophageal and ovarian ca without osseous mets~ What Causes It?

5. • Is hypercalcemia always symptomatic? • Early symptoms include nausea anorexia & vomiting • Permanent renal tubular damage may occur • Myocardial instability may cause arrhythmias/sudden death • Neurological symptoms may predominate Hypercalcemia Therapy

6. Severe Hypercalcemia Serum total ca (mmol/L) 4 3 2 16 12 8 (mg/dl) Normal range for Serum calcium Moderate Hypercalcemia Mild Hypercalcemia Normocalcemia Mild hypocalcaemia Serum total ca

7. • Decrease oral intake of ca?? • Promote urinary excretion • Decrease bone resorption • Antitumor therapy Hypercalcemia Therapy

8. • Fluid deficit • Which fluid---normal saline • 300-500 ml/hr initially • May need 3-4 litres in 24 hrs • Saline diuresis 100-200 ml/hr • Add frusemide once hydrated Hypercalcemia Therapy Hydration

9. • Improves renal handling of ca only • Aggressive fluid therapy assoc with high morbidity • May need ICU monitoring • Hi ca may not be corrected Hypercalcemia Therapy Hydration

10. • Corticosteroids • Bisphosphonates • Cacitonin • Gallium nitrate • Mithramycin Hypercalcemia Therapy Decreasing bone resorption

11. • Blocks bone resorption due to Cyk & Lyk • High doses – Increase ca excretion – Inhibit Vit D metabolism – Decrease ca absorption – Neg ca balance in bone • May inhibit growth of neoplastic tissue Hypercalcemia Therapy Corticosteroid s

12. • Effective in hi ca due to Lymp/ MM/ Leuk/ ?Breast ca • 200-300 mg hydrocortisone may be needed dailyx3-5 days • 100 mg Pred orally for several days • Use in non haematological tumours?? • Use with calcitonin?? Hypercalcemia Therapy Corticosteroid s

13. • Decreases bone resorption • Decrease tubular reabsorption • Ca reduction within hours • Tachyphylaxis may develop • Down regulation of receptors on osteoclast surface Hypercalcemia Therapy Calcitonin

14. • 4-8 MRC units/kg-12 hrly I/M, S/C • Nausea/ flushing/ abdominal cramps/allergy • If tachyphylaxis discontinue and reinstitute • Add glucocorticoides Hypercalcemia Therapy Calcitonin

15. • Bind to hydroxyapatite crystals in bone matrix • Inhibits dissolution • Blocks maturation of osteoclast • Osteoclast apoptosis • Affect the signalling pathway between osteoblasts & osteoclasts HypercalcemiaTherapy Bisphosphonates

16. • Oral route unreliable 1-2% Bioavailibility • I/V route preferred • 3-5mg/kg/d, 3-5hrs/ 3-5 days • Single infusion 4 hrs 1.5 g • May be followed by oral Clodronate Hypercalcemia Therapy Clodronate

17. • Ca decreases in 2-3 days • Duration of effect 10-12 days • Humoral-hypercalcemia responds poorly • 30% retained in bone 1/2 life >1yr Hypercalcemia Therapy Clodronate

18. • Gallium nitrate • Mithramycin • Phosphate • Antitumour therapy Hypercalcemia Therapy

19. • Hydration-fluid/electrolyte balance • Bisphosphonates+/-Calcitonin • Corticosteroids • Early mobilization • Care of constipation • Avoid drugs causing hi ca Hypercalcemia Therapy Conclusion

Add a comment