tanmaynator
Forum Senior
Topics: 12
Posts: 153
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hypercalcemia of malignancy what to do??
some case scenario where there is hypercalcemia of malignancy.. eg serum Ca around 12 to 14.. what to do as immediate next step in management??
give iv normal saline according to kaplan
or
give iv bisphosphonate according to UW..
so what do we actually put in as the answer..
can somebody help me out here??
thanks..
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| DrVirgo
Forum Hero
Topics: 1096
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I think for asymptomatic hypercalcemia under 12 you can start with fluid replacement.
For symptomatic hypercalcemia, you can give bisphosphonates.
(correct me if i'm wrong)
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| sailing boat
Forum Elite
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i think, we should give bisphosphanates, cause hypercalcemia of malignancy, is mostly caused by il-1 or pthr so, it will lea d to bone resorption, hence bisphosphanates would be better, not n saline
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| Justice
Forum Fanatic
Topics: 117
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sailing boat wrote:
i think, we should give bisphosphanates, cause hypercalcemia of malignancy, is mostly caused by il-1 or pthr so, it will lea d to bone resorption, hence bisphosphanates would be better, not n saline
The Q is about immediate next step in management, right? I think normal saline fits the situation... Biphospho won't work on Ca concentration in blood...
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| sprint123
Forum Guru
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I agree with DrVirgo
Asymptomatic--> Alendronate
Symptomatic--> Iv fluids and diuretics
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| sailing boat
Forum Elite
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well see this q , this is from uw,
and acc to it, whn hypercalcemia due to malignancy, always giove bisphosphanates
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| sailing boat
Forum Elite
Topics: 54
Posts: 172
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sailing boat wrote:
well see this q sprint and justice , this is from uw,
and acc to it, whn hypercalcemia due to malignancy, always giove bisphosphanates
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| virgola82
Forum Guru
Topics: 85
Posts: 348
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I agree with Dr Virgo but I think the biphosphonate of choice should be zoledronic acid instead of alendronate in case of hypercalcemia of malignancy.
So in review I'd say:
Mild hypercalcemia -> Zoledronic acid
Severe (Signs and symptoms present) Hypercalcemia -> 1. IV saline, 2. When patient is rehydrated give Lasix (you don't wanna give a diuretic to a dehydrated pt...)
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| tanmaynator
Forum Senior
Topics: 12
Posts: 153
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thanks guys..
i was really confused about that one.. and specially sailing boat.. i remembered the answer from uw but had forgotten its explaination..
thanks guys..
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| sailing boat
Forum Elite
Topics: 54
Posts: 172
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so guys this is wht u re saying,m if he is having hypercalcemia due to malignancy,
then give zolendronic acid, if ca 11-12
give i.v fluids, and after fluids zolendronic acid, if ca 12or greater
and wht is next best step if it were hypercalcemia due to hyperparathroidism, before going for surgery????
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| cirus
Forum Guru
Topics: 108
Posts: 740
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adding to ur conflict I just solved 2 quests today asking about the subst contributing to Ca increase in 2 diff malignancies
so here goes (from UW)
from non metast solid tumor ( most com-> Breast & Lungs)Parathyroid Hor related peptide (PTHrP)
from metast-->cytokines--> 1. IL1 2. TNF
from Hodgik--> Calcitriol
Other--->ectopic PTH (rare)
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