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Effective treatments reduce serum calcium by inhibiting bone resorption, increasing urinary calcium excretion, or decreasing intestinal calcium absorption (table 1). The optimal choice varies with the cause and severity of hypercalcemia.
• Calcitonin – For immediate, short-term management of hypercalcemia in symptomatic patients (eg, lethargy, stupor) with calcium >14 mg/dL (3.5 mmol/L), we suggest administration of calcitonin . Calcitonin is used in combination with saline hydration and bisphosphonates.
Reduction of calcium during dialysis. RANKL: receptor activator of nuclear factor kappa-B ligand; PTH: parathyroid hormone; CKD: chronic kidney disease. * The efficacy of calcitonin is limited to the first 48 hours, even with repeated doses, due to the development of tachyphylaxis.
Nasal human calcitonin for tumor-induced hypercalcemia. AU Dumon JC, Magritte A, Body JJ SO Calcif Tissue Int. 1992;51(1):18. We treated four hypercalcemic cancer patients by nasal hCT, 3 x 2 mg daily, which has been reported to be active in Paget's disease at lower doses.
This topic will review the major clinical manifestations directly associated with hypercalcemia. The clinical manifestations more directly associated with hyperparathyroidism and the diagnostic approach to and treatment of hypercalcemia are discussed separately.
Injectable salmon calcitonin has been in use in the United States for more than a decade for the treatment of patients with postmenopausal osteoporosis, Paget's disease, and hypercalcemia. Sandoz Pharmaceuticals Corp. is currently in the process of developing a nasal formulation of salmon calcitonin.
Nasal human calcitonin for tumor-induced hypercalcemia. AU Dumon JC, Magritte A, Body JJ SO Calcif Tissue Int. 1992;51(1):18. We treated four hypercalcemic cancer patients by nasal hCT, 3 x 2 mg daily, which has been reported to be active in Paget's disease at lower doses.
The first step in the evaluation of a patient with hypercalcemia is to verify with repeat measurement (total calcium corrected for albumin) that there is a true increase in the serum calcium concentration. If available, previous values for serum calcium should also be reviewed.
Among all causes of hypercalcemia, primary hyperparathyroidism and malignancy are the most common, accounting for greater than 90 percent of cases (table 1). This topic will review the etiology of hypercalcemia. The clinical manifestations, diagnostic approach, and treatment are reviewed separately.
Injectable salmon calcitonin has been in use in the United States for more than a decade for the treatment of patients with postmenopausal osteoporosis, Paget's disease, and hypercalcemia. Sandoz Pharmaceuticals Corp. is currently in the process of developing a nasal formulation of salmon calcitonin.