A 53-year-old woman who is being treated for metastatic breast cancer is noted to have some lethargy, fatigue, and an elevated serum calcium level. She is brought into the ER for near comatose state, thought to be caused by the hypercalcemia. After addressing the ABCs (airway, breathing, circulation), wof is the best therapy for this patient
Hypercalcaemia of malignancy:- Severe hypercalcaemia, a common complication of malignancy, is a medical emergency with altered consciousness. Treatment:- Pamidronate or zoledronate are the most effective drugs, but take 24-48 hours to act. They may be supplemented by i.m. calcitonin 6-12 hourly for 2 days to achieve rapid action. Vigorous i.v. hydration is instituted first. After volume repletion, furosemide is added to enhance Ca2+ excretion and to prevent volume overload. This is followed by BPN infusion. This therapy reduces serum calcium within few hours and corrects the attending dehydration. Oral BPNs are not useful. Coicosteroids also lower plasma Ca2+, but are slow to act, take 1-2 weeks. Ref:- kd tripathi; pg num:-344
Bisphosphonates
IV estrogen therapy
Saline infusion and furosemide
Vitamin D
Endocrinology