No abstract

The serum calcium level was 17 mg/100 ml and the total serum protein level was 7 gm/100 ml. X-ray examination revealed generalized demineralization, multiple cystic bone lesions, and a pathological fracture of the left humeral shaft. At neck exploration a 14V2-gm encapsulated tumor was removed from the region of the right lower thyroid pole. Microscopic sections were "con-

Comparative effectiveness of six to eight hour infusions of phosphate, sulfate, and hydrocortisone was studied in 22 hypercalcemic patients with neoplastic disease. Mean maximum reduction in serum calcium level with phosphate was dose dependent: 25 millimols, 1.1 mg/100 ml; 50 millimols, 2.44 mg/100 ml; 75 millimols, 4.13 mg/ 100 ml; and 100 millimols, 6.08 mg/100 ml. The reduction was also directly related to the rise in serum phosphate level. Sulfate infusion (38.9 gm) caused an average max-imum decrease of serum calcium of 1.87 mg/100 ml. Hydrocortisone (200 mg) produced minor inconsistent changes in serum calcium and phosphate levels. Infusions of phosphate caused reduction in urinary calcium and rise in phosphate level. Both sulfate and hydrocortisone infusions resulted in rises in urinary calcium and urinary phosphate. These studies demonstrate the superiority of phosphate in treatment of hypercalcemia and suggest guidelines for dose selection.