samerhasna
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what is the initial emergent treatment of acute svere hypercalcemia?
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| dr79
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according to my knowledge...acute severe hypercalcemia is treated by I/V saline and promotion of diuresis...
in less severe cases as well as chronic, Biophosphates r given
correct me guys if im wrong
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| chemamr
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IV hydration with furosemide.
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| samerhasna
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cprrect chemamr:3-4L of NS + 40mg of furosemide while keeping a clse watch to potasium levels
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| dr79
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suggests i was right...aint it?
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| samerhasna
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  yes you are dear dr79
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| mani
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u poeple r correct but be informed about when to add diuretic, not everybody needs it in hypercalcemia...
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| samerhasna
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actually ddiuretics are contarindicated only if there is water depletion....then you add normal saline to replace it then you can add furosemid(cause it depletes calcium)
thiazids is not indicated for it save calcium
hypercalcemia associated with malignancy can't be trated
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| mani
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most of the patients of hypercalcemia r dehydrated and diuretic (furosemide) is indicated only if there r signs of vol overload eg pulmonary rales (CHF) etc
Edited by mani on 06/24/05 - 03:03 PM
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| samerhasna
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with my respect Mani:
if there is water depletion you should replace it and then apply furosemide....that is what I have read in many internal medicine books...
where you read what you have said just to let me reconsider my study resources
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| Springd
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I agree with mani, most of the time it can just be corrected with volume repletion
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| samerhasna
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Hey docs lease tell me where you read this....I use medstudy and it is somewhat a fulldetailed ereview book nut it is ofcourse not as current....I want to evaluate it and reconsider it
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| mani
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samerhasna this is given in kaplan. Medstudy is a good book but as u know not everything is given in a single book so just stick to whichever book u r using. Of course nobody is expected to know everything
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| chemamr
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You´re right mani. the first step must be only IV isotonic saline solution and this is usually enough.
2nd step in management: Diuretics (specifically furosemide) is used only in some cases, like you said.
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| samerhasna
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thanks for all of you
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| Vai
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most important and least toxic agent for the treatment of cancer-related emergency hyperCa(solid tumor eg. sq.cell of lung and no for hyper. vit.D induce hyperCa) only after adequate hydration with 0.99% saline are i.v. bisphosphonates ( zoledronic acid newest and better than pamidronate) - this is just what i read on several www source-
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| chemamr
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Good data Vai !
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| samerhasna
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if hypercalcemia associated with malignancy:NS and Furosemid to maintaine urine output up to 200mlhr and administration of bisphosphonate pamidronate
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