Acute Treatment of Hypercalcemia

Normal saline (4–6 L/d) h during Rx

Natriuresis → ↑ renal Ca excretion 排鈉 → ↑ 腎鈣排泄

Furosemide h during Rx

Use cautiously, only if volume overloaded

Bisphosphonates 1–2 d var.

Inhibit osteoclasts, useful in malignancy; caution in renal failure; risk of jaw osteonecrosis; monitor for hypocalcemia

• 抑制破骨細胞，對惡性腫瘤有用
• 腎功能衰竭要小心
• 頜骨壞死的風險
• 監測低鈣血症

Calcitonin h ~48 hrs

• Bridging Rx, quickly develop tachyphylaxis急速耐藥性

Glucocorticoids days days

• Useful in some malig, granulomatous disorders & vitamin D intox.
• pred. 20mg

Denosumab (JCEM 2014;99:3144) days months

• Monoclonal Ab against RANKL; typically used in hyperCa of malignancy; not renally cleared
• 針對 RANKL 的單克隆抗體；通常用於惡性腫瘤的 hyperCa；未被腎臟清除

Hemodialysis min during Rx

• If other measures ineffective or contraindicated