Aggressive hydration - Goal urine output is 3L in 24hr
≤7 or 25% decrease in baseline
Treat only if symptomatic (increased Ca leads to increased Ca/phos deposition), such as widened QRS or ventricular arrhythmias
Calcium gluconate 50-200mg IV
Treat only if symptomatic (increased Ca leads to increased Ca/phos deposition), such as widened QRS or ventricular arrhythmias
Calcium gluconate 50-200mg IV
Treat the underlying cause
Restrict calcium phosphate intake
IV Normal Saline (if normal renal fx)
Acetazolamide (500mg IV q6hr) - if normal renal function
Phosphate Binder - Aluminum hydroxide (50-150mg/kg PO q4-6h) - limited effect
Dialysis if refractory
Consider sevelamer 800-1600mg PO tid to avoid side effects of aluminum toxicity and hypercalcemia from aluminum hydroxide treatment
≥8 or 25% increase
Allopurinol
Acts slowly; only helpful for preventing future production of uric acid
10mg/kg/d PO q8 OR 200-400mg/m2 IV q12; renally dosed
Inhibition of xanthine oxidase can last 18-30h
Urate Oxidase
Rasburicase 0.05-0.2mg/kg IV
Can be used for BOTH prevention and treatment
Uric acid final product of purine metabolism
Urate oxidase converts uric acid to allantoin (5-10x more soluble)
Allopurinol
Acts slowly; only helpful for preventing future production of uric acid
10mg/kg/d PO q8 OR 200-400mg/m2 IV q12; renally dosed
Inhibition of xanthine oxidase can last 18-30h
Urate Oxidase
Rasburicase 0.05-0.2mg/kg IV
Can be used for BOTH prevention and treatment
Uric acid final product of purine metabolism
Urate oxidase converts uric acid to allantoin (5-10x more soluble)
Acts slowly; only helpful for preventing future production of uric acid
10mg/kg/d PO q8 OR 200-400mg/m2 IV q12; renally dosed
Inhibition of xanthine oxidase can last 18-30h
Rasburicase 0.05-0.2mg/kg IV
Can be used for BOTH prevention and treatment
Uric acid final product of purine metabolism
Urate oxidase converts uric acid to allantoin (5-10x more soluble)
Urate oxidase converts uric acid to allantoin (5-10x more soluble)
Only give Ca for cardiovascular instability (e.g.ventricular arrhythmias, widened QRS)
Giving Ca leads to increased Ca/phos deposition which leads to renal failure
See Hyperkalemia for treatment options
Giving Ca leads to increased Ca/phos deposition which leads to renal failure
Potassium >6
Significant renal insufficiency (Creatinine >10)
Uric Acid >10
Symptomatic hypocalcemia
Serum phosphorus >10
Volume overload
Tumor lysis syndrome
Malignant airway obstruction
Sepsis 
Bone metastases and pathologic fractures
Hemorrhagic shock
Malignant spinal cord compression
Neurogenic shock
Malignant Pericardial Effusion and Tamponade