What is the appropriate management for severe hypercalcemia?

Clinical Pearls Podcasts published on June 5, 2017
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Ruben Niesvizky, MD
Professor of Medicine
Weill Cornell Medical College
Director
Multiple Myeloma Center and Oncology Operations
New York Presbyterian Hospital/Weill Cornell Medicine
New York, New York

What is the appropriate management for severe hypercalcemia?

Severe Hypercalcemia in Multiple Myeloma (MM)

  • Hypercalcemia: one of the most severe and emergent challenges in MM
    • –   Results from metabolic derangements in the bone, metabolic management of electrolytes by the kidney
  • Management strategies
    • –   Hydration
    • –   Reduction of all potential risk factors
    • –   Reduction of calcium intake, vitamin D
    • –   Pharmacologic treatments
      • Corticosteroids
      • Bisphosphonates
      • Calcitonin
      • Chemotherapy agents (older)

Suggested Management Algorithm

  1. Hydration
  2. Elimination of all potential nephrotoxicities
  3. Calcitonin SQ
  4. Denosumab (indication: hypercalcemia of malignancy)
  5. Corticosteroids (hydrocortisone, methylprednisolone, dexamethasone)
  6. Bisphosphonates (potential risk of nephrotoxicity)
Last modified: April 14, 2017
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