Oncologic Emergencies Dr Karenza Alexis

Hypercalcemia of malignancy

• Diagnosis
• Ionized calcium, Serum immunoreactive PTH- like substance, phosphorus, 1,25 dihydroxyvitamin D
• If calcium only mildly elevated (<12) AND NO symptoms: encourage PO hydration, eliminate any offending agents, follow closely

• If calcium is >12 OR symptoms:

• saline infusion (be aware of cardiac and renal function),
• loop diuretics (once euvolemia achieved). Follow urine output and potassium, magnesium.
• Bisphosphonates inhibit osteoclast function e.g pamidronate
• Onset of action 24 to 48 hours
• Calcitonin
• Inhibits bone degradation by binding directly to receptors on the osteoclast
• onset of action is 2-4h but effect of short duration. Dose is 2-8 U/kg SC or IM every 6-12 h

•