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Hypercalcemia of Malignancy

See Also
1. Hypercalcemia
Epidemiology
1. Incidence: 20-30% of cancer patients
Pathophysiology
1. Circulating bone-resorbing cytokines, calcitriol
2. Tumor secretes Parathyroid Hormone related peptide
Causes
1. Multiple Myeloma
2. Lung Cancer
3. Breast Cancer
4. Kidney cancer
Symptoms
1. Nausea or Vomiting
2. Constipation
3. Altered Level of Consciousness to coma
4. Acute Renal Failure
Management
1. See Hypercalcemia for other management
2. Aggressive rehydration (up to 4 liters NS/24 hours)
3. Furosemide 10-20 mg IV q6-12 hours after rehydration
4. Follow serum electrolytes
  1. Serum Calcium (may start as high as 14 mg/dl)
  2. Replace phosphorous if Serum phosphate <3 mg/dl
    1. Neutro-Phos 250 mg Phosphorous PO or NG daily
5. Inhibit bone resorption
  1. Zoledronic acid: 4 mg IV over 15 min
    1. Preferred over Aredia
    2. Major (2001) J Clin Oncol 19:558
  2. Pamidronate (Aredia) 60-90 mg IV q4 hours
6. Consider dialysis if Renal Failure is present
Prognosis
1. Poor cancer prognostic sign
  1. Associated with >50% mortality in 30 days
References
1. Stewart (2005) N Engl J Med 352:373

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.