Hypercalcaemia

Level > 3.5 mmol/l is a medical emergency with problems of:

• cardiovascular collapse
• decreased mental state and coma
• polyuria and renal failure.

Commonest Causes

• multiple myeloma
• metastatic bone tumours
• ectopic PTH like hormone producing tumours.

Treatment

• Hydration with Normal Saline (4-6 1/day).
• Forced diuresis (Normal Saline + Frusemide) .
  • Once volume deficits corrected -  frusemide is 20-40 mg 6-12/24.
• Biphosphanates - (APD or Pamidronate).
  • Potent inhibitor of osteoclasts.
  • Onset of action over 1-2 days.
  • Dose of 15-90 mgs returns calcium to normal for weeks to months.
• Steroids - (Prednisolone 50 mg)
  • adjunctive therapy by promoting tumour lysis and decreasing GIT absorption
• Resistant hypercalcaemia - EDTA or dialysis.

NB. Hartmanns solution and Haemacell contraindicated because both contain calcium.