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
- Hydration
- Elimination of all potential nephrotoxicities
- Calcitonin SQ
- Denosumab (indication: hypercalcemia of malignancy)
- Corticosteroids (hydrocortisone, methylprednisolone, dexamethasone)
- Bisphosphonates (potential risk of nephrotoxicity)
