All are used in treatment of hypercalcemia ,except-
Surgery is the definitive treatment. Presence of coma in parathyroid storm or crisis is an indication for urgent medical management followed by surgery Indications for surgery are: i.symptoms of hypercalcaemia ii.serum Ca++ >12 mg% (1 mg increase over normal) iii.nephrolithiasis/24 hour urinary calcium excretion > 400 mg. iv.reduced bone mass (Bone scan T-score < 2.5) v.age < 50 years vi.inability for long-term follow-up vii.Creatinine clearance reduced by 30%. 2.Transcutaneous injection of parathyroid mass with alcohol under ultrasound guide 3.Monitor hypocalcaemia postoperatively for more than 14 days 4.Incidence of complication is high in alcohol ablation. 5.In case of hyperplasia of parathyroid all the 4 glands are surgically removed and pa of an excised gland is implanted into the forearm to maintain calcium and phosphorus metabolism 6.Medical treatment is indicated in presence of dangerous hypercalcaemia (> 15 mg/dl) or when surgical treatment is unsuccessful.7.The role for Raloxifene, a selective oestrogen response modulator with bone protective effect of oestrogen is under evaluation. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE 4TH EDITION PAGE NO-631
Phosphate
Mithramycin
Vitamin D in high dose
Any of the above
Endocrinology