Treatment of hypercalcemia. Comparison of intravenously administered phosphate, sulfate, and hydrocortisone

Fulmer, David H.

doi:10.1001/archinte.129.6.923

Cited by 27 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intravenous neutral phosphate (40 mmol infused slowly over 4-6 h) is an effective treatment for most types of hypercalcaemia (Fulmer et al, 1972;Goldsmith & Ingbar, 1966). Serum calcium values start to fall within a few minutes of administration, due to precipitation of insoluble calcium-phosphate complexes in bone and soft tissues, although subsequently, there may be an inhibitory effect on osteoclastic bone resorption (Herbert et al, 1966).…”

Section: Intravenous Phosphatementioning

confidence: 99%

“…Serum calcium values start to fall within a few minutes of administration, due to precipitation of insoluble calcium-phosphate complexes in bone and soft tissues, although subsequently, there may be an inhibitory effect on osteoclastic bone resorption (Herbert et al, 1966). The duration of action is relatively brief and in most patients, serum calcium values start to rise once again after 2-3 days (Fulmer et al, 1972).…”

Section: Intravenous Phosphatementioning

confidence: 99%

See 1 more Smart Citation

Medical management of hypercalcaemia.

Ralston¹

1992

Brit J Clinical Pharma

View full text Add to dashboard Cite

1. Hypercalcaemia is a common disorder, which frequently requires specific treatment either to control symptoms, or to prevent the development of irreversible organ damage or death. Although the best and most effective way of controlling hypercalcaemia in the long‐term is to treat the underlying cause, medical antihypercalcaemic therapy is often required in clinical practice, either as a holding measure, or because the primary disease cannot itself be treated. 2. The mainstays of medical antihypercalcaemic therapy are firstly, to promote calcium excretion by the kidney by restoring extracellular volume with intravenous saline and secondly, to administer pharmacological agents which inhibit bone resorption. Measures which seek to reduce intestinal calcium absorption are seldom effective. 3. Intravenous bisphosphonates are the treatment of first choice for the initial management of hypercalcaemia, followed by continued oral, or repeated intravenous bisphosphonates to prevent relapse. These drugs have a relatively slow onset of action (1‐3 days) but have potent and sustained inhibitory effects on bone resorption, resulting in a long duration of action (12‐ 30 days). 4. Of the other agents available, calcitonin has an important place in the management of severe hypercalcaemia where a rapid effect is desirable; calcitonin is best used in conjunction with a bisphosphonate however, because of its short duration of action. Intravenous phosphate also has a place in the emergency management of severe hypercalcaemia, but is probably best reserved for patients in whom other less toxic therapies have failed. Corticosteroids are generally ineffective except in certain specific instances and are best avoided in the routine treatment of undiagnosed hypercalcaemia.

show abstract

Section: Intravenous Phosphatementioning

confidence: 99%

Section: Intravenous Phosphatementioning

confidence: 99%

Medical management of hypercalcaemia.

Ralston¹

1992

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Intravenous Phosphate. Parenteral phosphate (50 to 100 mm in saline given over four to six hours) will effectively lower serum calcium levels [72], but should be given only once. Because this therapy may lead to calcium deposition in soft tissues including the heart, kidney, and lungs, we reserve it for clinical situations requiring urgent treatment when other modalities are ineffective and the patient will die unless the calcium is lowered.…”

Section: Twenty-four-hour Urine Calcium and Creat-mentioning

confidence: 99%

Hypercalcemia in the Critically Ill Patient

Reasner

Mundy

1986

J Intensive Care Med

View full text Add to dashboard Cite

Hypercalcemia is now frequently recognized in hospitalized patients, including those who are critically ill. Hypercalcemia in critically ill patients may be life threatening or an indication of an underlying but unsuspected disease process. All of the common causes of hypercalcemia can occur in the critically ill patient and are reviewed here. As in the general patient population, the two most common causes are probably malignant disease and primary hyperparathyroidism. Hypercalcemia is now readily reversible in most patients, particularly when the underlying pathophysiologic mechanisms responsible are recognized, and it should be treated actively.In the initial evaluation of hypercalcemia in a critically ill patient, the physician must decide if the elevated serum calcium level is responsible for the patient's condition or is merely an incidental finding that poses no immediate danger. Patients in the former category are said to be in hypercalcemic crisis, and they require immediate treatment to lower their serum calcium levels, which are life threatening. In the intensive care setting, hypercalcemic crisis is most commonly associated with primary hyperparathyroidism or malignancy. With the advent of automated screening procedures, asymptomatic hypercalcemia is frequently seen in hospitalized patients as well as outpatients [1], and mild hypercalcemia is at least as common in intensive care patients as in other patient populations. In this article we review the pathogenesis and treatment of the various conditions associated with hypercalcemia, particularly those diseases that are more likely to be seen in a critically ill patient. PathogenesisNormally, plasma calcium levels are maintained within narrow limits by the parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D. Hypocalcemia triggers PTH release, which (1) stimulates 1,25-dihydroxyvitamin D synthesis by the kidney and leads to increased intestinal calcium absorption, (2) directly stimulates osteoclastic bone resorption, and (3) increases calcium reabsorption in the distal tubules of the kidney. Hypercalcemia occurs when increased bone resorption or gut absorption of calcium leads to an influx of calcium into the extracellular fluid, which overwhelms the compensatory homeostatic mechanisms that maintain the serum calcium in the normal range. Hypercalcemia itself may cause vomiting and a decrease in the renal concentrating mechanism. This leads to dehydration and further increases in plasma calcium levels.

show abstract

“…If these tests are not available, electrocardiographic recordings are helpful. The infusion may be repeated after 24 hr but should not be repeated if there is evidence of a rising blood urea, oliguria or an elevated serum phosphorus more than 24 hr after the infusion (Fulmer et al, 1972). Intravenous phosphate therapy is very effective in reducing the serum calcium and may lead to a rapid improvement in the very ill patient with severe hypercalcaemia.…”

Section: Phosphatementioning

confidence: 99%

“…In addition some of the patients with side effects were already dangerously ill with the hypercalcaemia or with the neoplastic disease itself. Most workers have used cautious phosphate infusions without difficulty (Stamp, 1971;Fulmer et al, 1972).…”

Section: Side Effectsmentioning

confidence: 99%

Drugs for the treatment of hypercalcaemia

Paterson

1974

Postgraduate Medical Journal

View full text Add to dashboard Cite

Summary Hypercalcaemia is ordinarily treated by treatment of the underlying disorder. In some cases, as in malignant disease, in vitamin D poisoning and after a failed parathyroidectomy, the hypercalcaemia itself needs to be treated. A large number of methods have been advocated for this, but phosphate is the drug of choice in most patients. This paper outlines its use, mode of action and side effects and reviews the other methods proposed for the management of hypercalcaemia.

show abstract

Treatment of hypercalcemia. Comparison of intravenously administered phosphate, sulfate, and hydrocortisone

Cited by 27 publications

References 21 publications

Medical management of hypercalcaemia.

Medical management of hypercalcaemia.

Hypercalcemia in the Critically Ill Patient

Drugs for the treatment of hypercalcaemia

Contact Info

Product

Resources

About