Hypercalcaemia is seen in around 20-30% of patients with cancer (1).
It may develop by a combination of increased osteoclastic bone resorption and increased absorption of calcium by the kidney.
PTH levels are suppressed and calcitriol levels are normal (3).
The precise intervention required is dependent upon the level of the hypercalcaemia. In all cases, rehydration is necessary using 3-4 litres of 0.9% saline intravenously over 24 hours and subsequently 2-3 litres/day till a satiafactroy urine output (2 L/day) is established (2).
Frusemide should be given only in the presence or expectation of cardiac failure.
Pamidronate can be added to the hydration fluid. It takes 24-48 hours to take effect with full effect at 4-7 days. In the presence of renal impairment i.e. serum creatinine greater than 400, the pamidronate should be administered in daily divided doses.
Treatment may be repeated at 30 days.
Reference:
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