Key notes on symptom control issues in Palliative Care

Management of Hypercalcaemia (cont)

If the decision is made that the patient is too poorly to treat then it is inappropriate to check the calcium level. Appropriate symptom control measures should be instituted. This will include managing nausea and vomiting, ensuring adequate pain control and considering sedation if the patient is agitated. The situation may well warrant the use of a syringe driver.

If the decision is made that it would be appropriate to treat if the patient is hypercalcaemia then admit to an appropriate institution for the following treatment.

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  IV rehydration with at least two litres of normal saline (more if the patient is clinically dehydrated). Slow rate of hydration if there are signs of fluid overload developing.
  

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  Give an appropriate dose of pamidronate, reconstituted in 500ml of normal saline and infused over at least two hours.
  

2.8 – 3.0 mmol/l 30mg pamidronate

3.1- 3.4 mmol/l 60mg pamidronate

3.5 or more 90mg pamidronate

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  if successful in improving symptoms and the patients physical state allows check calcium level after five days. The calcium level should then be checked every six weeks and if increasing the pamidronate infusion repeated with prehydration with a litre of normal saline.
  
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  If there is no improvement in the patient’s condition, review decision to treat. If still felt to be appropriate repeat pamidronate infusion using 90mg dose. If resistant to this second dose discontinue treatment.