Avoid empiric treatment in patients taking digoxin due to risk for Stone Heart
Asymptomatic
Calcium gluconate 1 gm PO Q6hrs
Vitamin D (calcitriol) 0.2 mcg BID
Symptomatic
Calcium gluconate/calcium chloride 10mL of 10% soln IV over 10min
Correct hypomag at same time (otherwise PTH is inhibited)
Avoid phenothiazine antipsychotics (may precipitate extrapyramidal symptoms)
Avoid furosemide (may worsen hypocalcemia)
Calcium gluconate 1 gm PO Q6hrs
Vitamin D (calcitriol) 0.2 mcg BID
Calcium gluconate/calcium chloride 10mL of 10% soln IV over 10min
Does not require immediate treatment
Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)
May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)
Patients are likely dehydrated and require saline hydration as initial therapy
Isotonic saline at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour
Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
Tachyphylaxis limits use long term, but is a great choice for emergent cases
Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)
Pamidronate 90mg IV over 24 hours OR
Zoledronate 4mg IV over 15 minutes
Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure
Correct hypokalemia
Correct hypomagnesemia
Furosemide is NOT routinely recommended
Only consider in patients with renal insufficiency or heart failure and volume overload
Consider if patient:
Anuric with Renal Failure
Failing all other therapy
Severe hypervolemia not amenable to diuresis
Serum Calcium level >18mg/dL
Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)
Prednisone 60mg PO daily
Hyperparathyroidism
Addison's disease
Hypoparathyroidism
Calciphylaxis
Hypothyroidism
Excess vitamin D
Hyperthyroidism
Hypercalcemia of malignancy