The goal of therapy is to treat the hypercalcaemia first and subsequently effort is directed to treat the underlying cause. Fluids and diuretics Initial therapy: * hydration, increasing salt intake, and forced diuresis. * hydration is needed because many patients are dehydrated due to vomiting or kidney defects in concentrating urine. * increased salt intake also can increase body fluid volume as well as increasing urine sodium excretion, which further increases urinary calcium excretion. * after rehydration, a loop diuretic such as furosemide can be given to permit continued large volume intravenous salt and water replacement while minimizing the risk of blood volume overload and pulmonary oedema. In addition, loop diuretics tend to depress calcium reabsorption by the kidney thereby helping to lower blood calcium levels * can usually decrease serum calcium by 1–3 mg/dL within 24 hours * caution must be taken to prevent potassium or magnesium depletion Bisphosphonates and calcitonin Additional therapy: * bisphosphonates are pyrophosphate analogues with high affinity for bone, especially areas of high bone-turnover. * they are taken up by osteoclasts and inhibit osteoclastic bone resorption * current available drugs include (in order of potency): (1st gen) etidronate, (2nd gen) tiludronate, IV pamidronate, alendronate (3rd gen) zoledronate and risedronate * all people with cancer-associated hypercalcaemia should receive treatment with bisphosphonates since the 'first line' therapy (above) cannot be continued indefinitely nor is it without risk. Further, even if the 'first line' therapy has been effective, it is a virtual certainty that the hypercalcaemia will recur in the person with hypercalcaemia of malignancy. Use of bisphosphonates in such circumstances, then, becomes both therapeutic and preventative * people in kidney failure and hypercalcaemia should have a risk-benefit analysis before being given bisphosphonates, since they are relatively contraindicated in kidney failure. * Calcitonin blocks bone resorption and also increases urinary calcium excretion by inhibiting calcium reabsorption by the kidney * Usually used in life-threatening hypercalcaemia along with rehydration, diuresis, and bisphosphonates * Helps prevent recurrence of hypercalcaemia * Dose is 4 international units per kilogram via subcutaneous or intramuscular route every 12 hours, usually not continued indefinitely due to quick onset of decreased response to calcitonin Other therapies * rarely used, or used in special circumstances * plicamycin inhibits bone resorption (rarely used) * gallium nitrate inhibits bone resorption and changes structure of bone crystals (rarely used) * glucocorticoids increase urinary calcium excretion and decrease intestinal calcium absorption * no effect on calcium level in normal or primary hyperparathyroidism * effective in hypercalcaemia due to osteolytic malignancies (multiple myeloma, leukaemia, Hodgkin's lymphoma, carcinoma of the breast) due to antitumour properties * also effective in hypervitaminosis D and sarcoidosis * dialysis usually used in severe hypercalcaemia complicated by kidney failure. Supplemental phosphate should be monitored and added if necessary * phosphate therapy can correct the hypophosphataemia in the face of hypercalcaemia and lower serum calcium
medical diagnosis of Hyperparathyroidism
medical cause of Hyperparathyroidism
medical cause of Hyperthyroidism
medical cause of Hypothyroidism
symptom of Hyperparathyroidism
complications of Hyperparathyroidism
medical cause of Hypophosphatemia
medical cause of Hyperphosphatemia