Advertisement
Research Article| Volume 7, ISSUE 1, P175-190, January 1991

Management of Severe Hypercalcemia

  • Author Footnotes
    * Fellow in Endocrinolgy and Metabolism
    Kelly D. Davis
    Correspondence
    Address reprint request to: Kelly D. Davis, MD, Endocrine Section, University of Pennsylvania School of Medicine, 620 Clinical Research Building, 422 Curie Boulevard, Philadelphia, PA 19104-4283
    Footnotes
    * Fellow in Endocrinolgy and Metabolism
    Affiliations
    From the Departtment of Medicine, Endocrine Section, Univercity of Pennsylvania of Medicine, Philadelphia, Pennsylvania
    Search for articles by this author
  • Author Footnotes
    † Associate Professor of Medicine
    Maurice F. Attie
    Footnotes
    † Associate Professor of Medicine
    Affiliations
    From the Departtment of Medicine, Endocrine Section, Univercity of Pennsylvania of Medicine, Philadelphia, Pennsylvania
    Search for articles by this author
  • Author Footnotes
    * Fellow in Endocrinolgy and Metabolism
    † Associate Professor of Medicine
DOI:https://doi.org/10.1016/S0749-0704(18)30330-0
Management of Severe Hypercalcemia
Previous ArticleHyperkalemia
Next ArticleHypocalcemic Crisis
      This paper is only available as a PDF. To read, Please Download here.
      Severe hypercalcemia is a medical emergency that usually results from excessive mobilization of skeletal calcium and decreased renal calcium excretion. Severe hypercalcemia is most often caused by a clinically obvious malignancy or primary hyperparathyroidism. Hypercalcemia usually responds to treatment with volume expansion, a pharmacologic inhibitor of bone resorption such as plica- mycin or disodium etidronate, and therapeutic measures directed at the primary disease process.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Critical Care Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Adams J.S.
        • Gacad M.A.
        Characterization of the 1-hydroxylation of vitamin D3 by cultured alveolar macrophages from patients with sarcoidosis.
        J Exp Med. 1985; 161: 755
        • Attie M.F.
        Treatment of hypercalcemia.
        Endocrinol Metab Clin North Am. 1989; 18: 807-827
        • Attie M.F.
        • Fallon M.D.
        • Spar B.
        • et al.
        Bone and parathyroid inhibitory effects of S-2(3 aminopropylamino)ethylphosphorothioic acid. Studies in experimental animals and cultured bone cells.
        J Clin Invest. 1985; 75: 1191-1197
        • Binstock M.L.
        • Mundy G.R.
        Effect of calcitonin and glucocorticoids in combination on the hypercalcemia of malignancy.
        Ann Intern Med. 1980; 93: 269
        • Body J.J.
        • Borkowski A.
        • Cleeren A.
        • et al.
        Treatment of malignancy-associated hypercalcemia with intravenous aminohydroxypropylidene diphosphonate.
        J Clin Oncol. 1986; 8: 1177-1183
        • Body J.J.
        • Magritte A.
        • Seraj F.
        • et al.
        Aminohydroxypropylidene bisphosphonate (APD) treatment for tumor-associated hypercalcemia: A randomized comparison between a 3-day treatment and single 24-hour infusions.
        J Bone Mineral Res. 1989; 4: 923-928
        • Brenner D.E.
        • Harvey H.A.
        • Lipton A.
        A study of prostaglandin E2, parathormone, and response to indomethacin in patients with hypercalcemia of malignancy.
        Cancer. 1982; 49: 556-561
        • Breuer R.I.
        • LeBauer J.
        Caution in the use of phosphates in the treatment of severe hypercalcemia.
        J Clin Endocrinol. 1967; 27: 695-698
        • Breukelen F.J.Mv.
        • Bijvoet O.L.M.
        • Frijlingk W.B.
        • et al.
        Efficacy of aminohydroxypropylidene bisphosphonate in hypercalcemia: Observations on regulation of serum calcium.
        Calcif Tissue Int. 1982; 34: 321-327
        • Broadus A.E.
        • Mangin M.
        • Ikeda K.
        • et al.
        Humoral hypercalcemia of cancer: Identification of a novel parathyroid hormone-like peptide.
        N Engl J Med. 1988; 319: 556-563
        • Burtis W.J.
        • Brady T.G.
        • Orloff J.J.
        • et al.
        Immunochemical characterization of circulating parathyroid hormone-related protein in patients with humoral hypercalcemia of cancer.
        N Engl J Med. 1990; 322: 1106-1112
        • Carano A.
        • Teitelbaum S.L.
        • Konsek J.D.
        • et al.
        Bisphosphonates directly inhibit the bone resorption activity of isolated avian osteoclasts in vitro.
        J Clin Invest. 1990; 85: 456461
        • Cardella C.J.
        • Birkin B.L.
        • Rapoport A.
        Role of dialysis in the treatment of severe hypercalcemia: Report of two cases successfully treated with hemodialysis and review of the literature.
        Clin Nephrol. 1979; 12: 285-290
        • Chapuy M.C.
        • et al.
        Effects of CI2MBP on hypercalcemia produced by bone metastases.
        J Clin Invest. 1980; 65: 1243-1247
        • Coggeshall J.
        • Merrill W.
        • Hande K.
        • et al.
        Implications of hypercalcemia with respect to diagnosis and treatment of lung cancer.
        Am J Med. 1986; 80: 325-328
        • Coombes R.C.
        • Neville A.M.
        • Bondy P.K.
        • et al.
        Failure of indomethacin to reduce hydroxyproline excretion or hypercalcemia in patients with breast cancer.
        Prostaglandins. 1976; 12: 1027-1035
        • Fallon M.D.
        Direct inhibition of osteoclast bone resorbing activity by WR-2721, a new hypocalcemic agent.
        Calcif Tissue Int. 1984; 36: 481
        • Fleisch H.
        Biphosphonates: History and experimental basis.
        Bone. 1987; 8: S23-S28
        • Fulmer D.H.
        • Dimich A.B.
        • Rothschild E.O.
        • et al.
        Treatment of hypercalcemia: Comparison of intravenously administered phosphate, sulfate, and hydrocortisone.
        Arch Intern Med. 1972; 129: 923-930
        • Glover D.
        • Riley L.
        • Carmichael K.
        • et al.
        Hypocalcemia and inhibition of parathyroid hormone secretion after administration of WR-2721 (a radioprotective and chemoprotective agent.
        N Engl J Med. 1983; 309: 1137-1141
        • Green L.
        • Donehower R.C.
        Hepatic toxicity of low doses of mithramycin in hypercalcemia.
        Cancer. 1984; 68: 1379
        • Gupta M.M.
        • Singh H.
        • Christian S.
        Peritoneal dialysis in the treatment of severe hypercalcemia.
        J Dialysis. 1980; 4 ((2-3): 129-138
        • Harris B.C.
        Single high-dose aminohydroxypropylidene diphosphonate infusions to treat cancer-associated hypercalcemia.
        Lancet. 1986; 1: 165
        • Harris W.H.
        • Heaney R.P.
        • Davis L.A.
        • et al.
        Stimulation of bone formation in vivo by phosphate supplementaton.
        Calcif Tissue Res. 1976; 22: 85-98
        • Hasling C.
        • Charles P.
        • Mosekilde L.
        Etidronate disodium in the management of malignancy-related hypercalcemia.
        Am J Med. 1987; 82: 51-54
        • Hebert L.A.
        • Lemann J.
        • Peterson J.R.
        • et al.
        Studies of the mechanism by which phosphate infusion lowers serum calcium concentration.
        J Clin Invest. 1966; 45: 1886-1894
        • Heyburn P.J.
        • Selby P.L.
        • Peacock M.
        • et al.
        Peritoneal dialysis in the management of severe hypercalcaemia.
        Br Med J. 1980; 280: 525-526
        • Hirschel-Scholz S.
        • Caverzasio J.
        • Bonjour J.B.
        Inhibition of parathyroid hormone secretion and parathyroid hormone-independent diminution of tubular calcium reabsorption by WR-2721, a unique hypocalcemic agent.
        J Clin Invest. 1985; 76: 18511856
        • Hirschel-Scholz S.
        • Caverzasio J.
        • Rizzoli R.
        • et al.
        Normalization of hypercalcemia associated with a decrease in renal calcium reabsorption in Leydig cell tumor-bearing rats treated with WR-2721.
        J Clin Invest. 1986; 78: 319-322
        • Hosking D.J.
        • Gilson D.
        Comparison of the renal and skeletal actions of calcitonin in the treatment of severe hypercalcaemia of malignancy.
        Q J Med. 1984; 53: 359-368
        • Jacobs T.P.
        • Gordon A.C.
        • Silverberg S.J.
        • et al.
        Neoplastic hypercalcemia; physiologic response to intravenous etidronate disodium.
        Am J Med. 1987; 82: S42-S50
        • Jung A.
        • Bisaz S.
        • Fleisch H.
        The binding of pyrophosphate and two diphosphonates by hydroxyapatite crystals.
        Calcif Tissue Res. 1973; 11: 269-280
        • Kanis J.A.
        • Urwin G.H.
        • Gray R.E.S.
        • et al.
        Effects of intravenous etidronate disodium on skeletal and calcium metabolism.
        Am J Med. 1987; 82: S55-S70
        • Kiang D.T.
        • Loken M.K.
        • Kennedy B.J.
        Mechanism of the hypocalcemic effect of mithramycin.
        J Clin Endocrinol Metab. 1979; 48: 341
        • Lukert B.P.
        • Stanbury S.W.
        • Mawer E.B.
        Vitamin D and intestinal transport of calcium: Effects of prednisolone.
        Endocrinology. 1973; 11: 716-726
        • Maierhofer W.J.
        • Gray R.W.
        • Lemann J.
        Phosphate deprivation increases serum 1,25-dihydroxyvitamin ]D concentrations in healthy men.
        Kidney Int. 1984; 25: 571-575
        • Mallette L.E.
        • Bilezikian J.P.
        • Heath D.A.
        • et al.
        Primary hyperparathyroidism: Clinical and biochemical features.
        Medicine. 1974; 53: 127-146
        • Mannix K.A.
        • Carmichael J.
        • Harris A.L.
        • et al.
        Single high-dose (45 mg) infusions of aminohydroxypropylidene diphosphonate for severe malignant hypercalcemia.
        Cancer. 1989; 64: 1358-1361
        • Mundy G.R.
        Hypercaleemic factors other than parathyroid hormone-related protein.
        Endocrinol Metab Clin North Am. 1989; 18: 795-806
        • Percival R.C.
        • Yates A.J.P.
        • Gray R.E.S.
        • et al.
        The role of glucocorticoids in the management of malignant hypercalcemia.
        Br Med J. 1984; 289: 287
        • Perlia C.P.
        • Gubish N.J.
        • Walter J.
        Mithramycin treatment of hypercalcemia.
        Cancer. 1970; 25: 389-394
        • Raisz L.G.
        • Trummel C.L.
        • Wener J.A.
        • et al.
        Effect of glucocorticoids on bone resorption in tissue culture.
        Endocrinology. 1972; 90: 961
        • Ralston S.H.
        • Gardner M.D.
        • Dryburgh F.J.
        • et al.
        Comparison of amino-hydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcemia.
        Lancet. 1985; 2: 907-909
        • Ryzen E.
        • Martodam R.M.
        • Troxell M.
        • et al.
        Intravenous etidronate in the management of malignant hypercalcemia.
        Arch Intern Med. 1985; 145: 449-452
        • Sandler L.M.
        • Winearls C.G.
        • Fraber L.J.
        Studies of the hypercalcemia of sarcoidosis: Effects of steroids and exogenous vitamin D3 on the circulating concentrations of 25-dihydroxyvitamin D.
        Q J Med. 1984; 53: 165
        • Schiller J.H.
        • Rasmussen A.B.
        • Benson R.S.
        • et al.
        Maintenance etidronate in the prevention of malignancy-associated hypercalcemia.
        Arch Intern Med. 1987; 147: 963-966
        • Shacknew S.
        • Hasson J.
        Precipitous fall in serum calcium, hypotension, and acute renal failure after intravenous phosphate therapy for hypercalcemia.
        Ann Intern Med. 1967; 66: 906-916
        • Singer F.R.
        • Neer R.M.
        • Murray T.M.
        • et al.
        Mithramycin treatment of intractable hypercalcemia due to parathyroid carcinoma.
        N Engl J Med. 1970; 283: 634-636
        • Sleeboom H.P.
        • Bijvoet O.L.
        • Osterom A.T.v.
        • et al.
        Comparison of intravenous (3-amino-l-hydroxypropylidene)-l,l-bisphosphonate and volume repletion in tumour-induced hypercalcemia.
        Lancet. 1983; 2: 239-243
        • Stewart A.F.
        • Horst R.
        • Deftos L.F.
        • et al.
        Biochemical evaluation of patients with malignancy-associated hypercalcemia: Evidence for humoral and nonhumoral groups.
        N Engl J Med. 1980; 303: 1377-1383
        • Suki N.
        • Yium J.J.
        • Minden M.V.
        • et al.
        Acute treatment of hypercalcemia with furosemide semide.
        N Engl J Med. 1970; 283: 836
        • Tashjian A.
        • Wright D.R.
        • Ivey J.L.
        • et al.
        Calcitonin binding sites in bone: Relationships to biological response and escape.
        Recent Prog Hor Res. 1978; 34: 285-334
        • Thiebaud D.
        • Jaeger P.
        • Gobelet C.
        • et al.
        A single infusion of the diphosphonate AHPrBP (APD) as treatment of Paget's disease of bone.
        Am J Med. 1988; 85: 207-212
        • Thiebaud D.
        • Jaeger P.
        • Jacquet A.F.
        • et al.
        A single-day treatment of tumor-induced hypercalcemia by intravenous amino-hydroxypropylidene bisphosphonate.
        J Bone Min Res. 1986; 1: 855-861
        • Thiebaud D.
        • Jaeger P.
        • Portmann L.
        • et al.
        Oral versus intravenous AHPrBP (APD) in the treatment of hypercalcemia of malignancy.
        Bone. 1986; 7: 247-253
        • Warrell R.P.
        • Israel R.
        • Frisone M.
        • et al.
        Gallium nitrate for acute treatment of cancer-related hypercalcemia. A randomized, double-blind comparison to calcitonin.
        Ann Intern Med. 1988; 108: 669-674
        • Warrell R.P.
        • Murphy W.K.
        • Schulman P.
        • et al.
        Gallium nitrate versus etidronate for acute treatment of cancer-related hypercalcemia: A randomized double-blind-study [abstract].
        Am Soc Bone Min Res. 1990; 5 (suppl 2): S271
        • Wong G.L.
        • Lukert B.P.
        • Adams J.S.
        Glucocorticoids increase osteoblast-like bone cell response to 1,25-dihydroxyvitamin D3.
        Nature. 1980; 285: 254

      Article info

      Identification

      DOI: https://doi.org/10.1016/S0749-0704(18)30330-0

      Copyright

      © 1991 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX