empearls

Hypercalcemia of Malignancy

Correct for albumin!

Mild = 10.5-11.9, consider dc if close f/u, pt asymptomatic

  • Oral hydration
  • High-salt diet
  • Avoid meds that cause hyperCa

Moderate = 12-13.9, admit

Severe = >14, admit

  • IVF, Goal UOP = 150ml/hr
  • Consider lasix
  • Consider bisphosphonates:

– zolendronic acid: 4mg IV over 15 minutes, 8mg 2nd dose if required – pamidronate: over 2-24 hours, give 60mg (Ca 12-13.5), give 90mg (Ca > 13.5)

If >18 or >13.5 with AMS, renal failure, CHF, emergent dialysis

Hyperviscosity Syndrome
  • Triad of bleeding, visual changes, neuro symptoms
  • Get CBCdiff, coags, BMP, peripheral smear for roulette formations, serum and urine electrophoresis
  • Careful hydration and diuresis
  • If extreme WBC, needs leukophoresis
  • If extreme proteinemia, needs plasmapheresis
  • If not immediately available, do 100-200cc phlebotomy