Not useful for acute Hypercalcemia?
Ans. is 'c' i.e., Furosemide Treatment for hypercalcemia depends upono The underlying disease.o The severity of hypercalcemia.o The serum inorganic phosphate level ando The renal hepatic and bone marrow function. o Mild hvpercalcemias< 3 mmol/l (12 mg/dl)-Managed by hydration aloneo More severe hvoercalcemia3.2 to 3.7 mmol/l (13 to 15 mg/dl)-Requires rapid correction measures other than hydration.It requires combination of approaches.o Life threatening hypercalcemia>3.7 mmol/L (15 mg/dL)-Requires emergency measures TreatementOnset of ActionDuration of ActionAdvantagesDisadvantagesMost Useful Therapies Hydration with salineHoursDuring infusionRehydration invariably neededVolume overloadForced diuresis; saline plus loop diureticHoursDuring treatmentRapid actionVolume overload, cardiac decompensation, intesive monitoring, eletrolyte disturbance, inconvenienceBisphosphonates Pamidronate1-2 days10-14 days to weeksHigh potency, intermediate onset of actionFever in 20%, hypophosphatemia, hypocalcemia rarely jaw necrosisZolendronate1-2 days> 3 weeksSame as for pamidronate (may last longer)Same as pamidronate aboveCalcitoninHours1-2 daysRapid onset of action; useful as adjunct in severe hypercalcemiaRapid tachyphylaxisSpecial Use therapies PhosphateOral24 hDuring useChronic management (with hypophosphatemia); low toxicity if P< 4 mg/dLLimited use except as adjuvant or chronic therapyGlucocorticoidsDaysDays, weeksOral therapy, antitumor agentActive only in certain malignancies vitamin D excess and sarcoidosis; glucocorticoid side effectsDialysisHoursDuring use and 24-48 afterwardUseful in renal failure; onset of effect in hours; can immediately reverse life-theratening hypercalcemiaComplex procedure, reserved for extreme or special circumstances
Normal saline
Calcitonin
Furosemide
Bisphosphonates
Fluid & Electrolyte