Hypercalcemia initial treatment

[DoctorMY]

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Initial treatment:

Who gets the IV saline hydration followed by loop diuretic first? who gets the bisphosphonates initially?

I've seen questions in UW qbank where they went with IV saline first and seen others where they gave the bisphosphonates(zometa i think it was) first.

I'm guessing in acute cases with psychiatric symptoms we should go for saline and diuretics bec it works quicker. but for chronically elevated as in malignancy we go with bisphosphonates.. am i right?

 

[turkeyjerky]

Acutely or severely symptomatic gets IV NS hydration, then diuretics (if the response to hydration alone was inadequate). Chronically mildly symptomatic gets outpatient work up and rx with bisphosphonates.

 

[SlaveOfTCMC]

what's the deal with the patient who:

1) gets IV NS + loop diuretic
2) pamidronate
3) calcitonin "while waiting for the 2-3 days for pamidronate to peak in activity"


does the super clinically sick hypercalcemic patient get all of those?

 

[Valadi]

what's the deal with the patient who:

1) gets IV NS + loop diuretic
2) pamidronate
3) calcitonin "while waiting for the 2-3 days for pamidronate to peak in activity"


does the super clinically sick hypercalcemic patient get all of those?

It depends. If the high calcium is secondary to ingestion, your bisphosphonate is not going to be necessary. If it's parathyroid or malignancy, they'll be more useful.

As an aside, even though the dogma for ages has been to give IVF + loops, the data on loop's usefulness is weak at best. So, you're unlikely to get a USMLE question that forces you to choose just a loop diuretic. Their answer choices tend to be super concrete. You are likely to have to choose IV fluids vs. a bisphosphonate vs. calcitonin. As an initial treatment, IV fluids will always be the right answer.

 

[DoctorMY]

thanks guys