Medication
Volume expansion with isotonic fluid is the initial treatment of choice for hypercalcemia of malignancy, leading to a decline in serum calcium of approximately 2 mg/dL (0.5 mmol/L).
Procedures
Machado CE, Flombaum CD. Safety of pamidronate in patients with renal failure and hypercalcemia. Clin Nephrol 1996; 45:175. Trimarchi H, Lombi F, Forrester M, et al. Disodium pamidronate for treating severe hypercalcemia in a hemodialysis patient.
Nutrition
Calcimimetics — Calcimimetic agents (only cinacalcet is currently available) reduces the serum calcium concentration in patients with severe hypercalcemia due to parathyroid carcinoma and in hemodialysis patients with an elevated calcium-phosphorous product and secondary hyperparathyroidism.
What is the initial treatment for hypercalcemia of malignancy?
Immobilization hypercalcaemia responding to intravenous pamidronate sodium therapy. Postgrad Med J 1989; 65:244. Gibbs CJ, Peacock M. Hypercalcaemia due to sarcoidosis corrects with bisphosphonate treatment. Postgrad Med J 1986; 62:937.
Which medications are used in the treatment of hypercalcemia in renal failure?
What is the role of calcimimetics in the treatment of hypercalcemia?
Which medications are used in the treatment of hypercalcaemia due to sarcoidosis?
Which medication is used to treat hypercalcemia temporarily in a patient who has cancer?
Bisphosphonates. Intravenous osteoporosis drugs, which can quickly lower calcium levels, are often used to treat hypercalcemia due to cancer.
Which therapy is the best option for long term control of the cancer that causes superior vena cava syndrome quizlet?
Radiation therapy (RT) has long been a mainstay of treatment of malignant SVCS.
Which therapy is the best option for long term control of the cancer that causes superior vena cava syndrome?
In patients with SVCS secondary to non–small-cell carcinoma of the lung, radiotherapy is the primary treatment.
Why is hypercalcemia oncologic emergency?
This oncologic emergency is characterized by the rupture of cells, which leads to severe electrolyte abnormalities and, frequently, acute renal failure. Either spontaneously or following antineoplastic therapy, malignant cells release their contents into the bloodstream (FIGURE 1).
When caring for the patient with chemotherapy induced mucositis which intervention will be most helpful?
Preventive measures for chemotherapy-induced mucositis include: Brushing with a soft toothbrush twice a day, flossing daily, and rinsing with bland solutions, such as normal saline, sodium bicarbonate, or tap water, at least four times a day are recommended.
Which class of medications treats chemotherapy induced nausea and vomiting?
Benzodiazepines. These agents are anxiolytics that are used in patients receiving chemotherapy. Benzodiazepines are appropriate adjunct therapies to decrease treatment-related anxiety, and they are the preferred agents to treat and prevent anticipatory nausea and vomiting.
What is the treatment for superior vena cava syndrome?
SVCS is serious when it occurs in adults. But it can be life-threatening in children. Symptoms include trouble breathing, coughing, and swelling of the face, neck, upper body, and arms. Treatment options for SVCS caused by cancer may include radiation therapy, chemotherapy, thrombolysis, and stent placement.
How is inferior vena cava syndrome treated?
The treatment of vena cava compression syndromes commonly involves stenting or radiation. Expandable metallic stents have been used to treat IVC compression caused by hepatic tumors [11]. Tumors that compress the SVC, such as lung cancer, are generally radiosensitive [12].
What is superior vena cava and inferior vena cava?
The vena cava has two parts: the superior vena cava and the inferior vena cava. The superior vena cava carries blood from the head, neck, arms, and chest. The inferior vena cava carries blood from the legs, feet, and organs in the abdomen and pelvis. The vena cava is the largest vein in the body.
What is the most common oncologic emergency?
Neutropenic fever (NF) is one of the most well-known oncologic emergencies. Up to 80% of patients receiving chemotherapy for hematologic malignancies will develop NF at least once during the course of therapy.
Is hypercalcemia a medical emergency?
Severe hypercalcemia is often considered an emergency because of a potential risk of cardiac arrest or coma.
How are oncologic emergencies treated?
Treatment options include chemotherapy, radiation, and intravenous stenting. Epidural spinal cord compression can be treated with dexamethasone, radiation, or surgery. Malignant pericardial effusion, which often is undiagnosed in cancer patients, can be treated with pericardiocentesis or a pericardial window procedure.
What is hypercalcemia of malignancy?
Hypercalcemia of malignancy is most commonly mediated by tumoral production of parathyroid hormone-related protein or by cytokines activating osteoclast degradation of bone. The initial workup, differential diagnoses, confirmatory laboratory testing, imaging, and medical and surgical management of hypercalcemia are described in ...
Is hypercalcemia a secondary disease?
This form of hypercalcemia is usually secondary ...
What is the treatment for hypercalcemia?
When the tumor is no longer amenable to surgical intervention, treatment becomes focused on the control of hypercalcemia with medical therapy, which can include bisphosphonates, calcimimetic agents, or denosumab. (See "Parathyroid carcinoma", section on 'Treatment' .)
How often can you take salmon calcitonin?
Salmon calcitonin (4 international units/kg) is usually administered intramuscularly or subcutaneously every 12 hours; doses can be increased up to 6 to 8 international units/kg every six hours. Nasal application of calcitonin is not efficacious for treatment of hypercalcemia [ 12 ].
What is the recommended serum calcium level for hemodialysis?
Hemodialysis should be considered, in addition to the above treatments, in patients who have serum calcium concentrations in the range of 18 to 20 mg/dL (4.5 to 5 mmol/L) and neurologic symptoms but a stable circulation or in those with severe hypercalcemia complicated by renal failure. (See 'Dialysis' below.)
How often can you repeat calcitonin?
If a hypocalcemic response is noted, then the patient is calcitonin sensitive and the calcitonin can be repeated every 6 to 12 hours (4 to 8 international units/kg). Patients may develop tachyphylaxis to calcitonin after 24 to 48 hours, so therapy is usually limited to this time period and then discontinued.
How long does it take for prednisone to lower calcium levels?
In such patients, glucocorticoids (eg, prednisone in a dose of 20 to 40 mg/day) will usually reduce serum calcium concentrations within two to five days by decreasing calcitriol production by the activated mononuclear cells in the lung and lymph nodes. (See "Hypercalcemia in granulomatous diseases" .)
Is hypercalcemia a clinical manifestation?
Hypercalcemia may be associated with a spectrum of clinical manifestations, ranging from few or no symptoms in patients with mild chronic hypercalcemia to severe obtundation and coma (see "Clinical manifestations of hypercalcemia" ).
How much water should I drink to prevent nephrolithiasis?
Adequate hydration (at least six to eight glasses of water per day) is recommended to minimize the risk of nephrolithiasis. Additional therapy depends mostly upon the cause of the hypercalcemia. (See 'Disease-specific approach' below.)
What is hypercalcemia of cancer?
It is associated with both liquid malignancies, commonly multiple myeloma, leukemia, and non-Hodgkins lymphoma and solid cancers, particularly breast and renal carcinomas as well as squamous cell carcinomas of any organ.
What percentage of cancer patients have hypercalcemia?
Epidemiology. First described in 1921, hypercalcemia of malignancy now occurs in upward of 20% of cancer patients during the course of their disease.1–3While exact estimates vary as a function of the population studied and the serum calcium cutoff used, hypercalcemia of malignancy is both the most common cause of hypercalcemia in cancer patients ...
What causes hypercalcemia?
Severe hypercalcemia is a potentially life-threatening complication of several diseases. Most commonly it is caused by cancers that enhance bone resorption. Impaired renal calcium excretion resulting from a combination of volume contraction and calcium-induced renal injury (nephrocalcinosis) plays a critical role in the genesis and aggravation ...
How long does it take for calcium to be reduced?
One of these agents in combination with volume expansion can reduce serum calcium concentrations to near normal in most patients within 3 to 6 days.
Can narcotics raise calcium levels?
Sedatives and narcotic analgesics, by reducing activity and oral intake, can raise serum calcium levels. In the future it may be possible to predict which patients with cancer are likely to develop accelerated local tumor-mediated or humorally mediated osteolysis.
Is hypercalcemia asymptomatic?
Patients with mild to moderate hypercalcemia may be asymptomatic. Therapy in these patients should be directed at the primary disease as well as at preventing complications that could raise the level of serum calcium. Efforts should be made to prevent volume contraction and prolonged bed rest.
Does calcitonin help with bone resorption?
Combining calcitonin with plicamycin or a bisphosphonate can enhance the rate of decline of the serum calcium level. Bone resorption also can be reduced by getting patients out of bed to stand or walk.
What is the pathology report of a patient with cancer?
It identifies genetic risk for specific cancers. The pathology report of a patient with cancer shows that the cells have broken off from the main tumor. The enzymes on the surface of the tumor cells are allowing cancer cells to enter blood vessels and travel around the body.
Can a patient with metastatic breast cancer eat?
A patient with metastatic breast cancer experiences severe nausea and vomiting after chemotherapy and is unable to eat. What is the nurse's most appropriate action? Administer antiemetic medications as prescribed. A patient with terminal liver cancer is concerned with the amount of pain he is experiencing.