Hypercalcemia in Hyperparathyroidism

Answer: d


Patients with marked hypercalcemia or severe symptoms should be admitted to the hospital for careful observation and monitoring. The mainstay of therapy is intravenous hydration, preferably with normal saline in sufficient quantities to maintain the urine output above 100 mL/h. These patients are often dehydrated before therapy, and fluid can be administered intravenously at a rate of 200 mL/h. Caution must be exercised in older patients who might have marginal cardiac reserve. The diuretic furosemide also increases excretion of sodium and calcium but should not be employed until the patient is well hydrated. Saline diuresis is usually effective when the hypercalcemia results from hyperparathyroidism or from a benign cause. In contrast, the hypercalcemia of malignancy may produce severe symptoms associated with extremely high serum calcium levels that are difficult to control. In this setting, a variety of other measures may be considered . Some of the agents used to treat hypercalcemia have significant toxicity and require close monitoring. Calcitonin is a fairly weak hypocalcemic agent, but it acts rapidly and is relatively less toxic. Glucocorticoids may be particularly efficacious in patients with sarcoidosis and other granulomatous diseases. Mithramycin has proved useful in patients with hypercalcemia of malignancy, but it has a substantial cumulative toxicity (thrombocytopenia, hepatotoxicity, and nephrotoxicity). Intravenous phosphates and chelating agents have largely been abandoned because of their severe toxicity.

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