Materiały źródłowe

• #1 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Not all cases of hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets can help. […] Be sure to talk with your healthcare provider if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your provider.

• #2 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Hypercalcemia is a serum calcium (Ca) level over two standard deviations above the average mean values. That equates to a total serum calcium level greater than 10.5 mg/dl or an ionized calcium level greater than 5.3 mg/dl. […] Early recognition and prompt diagnosis are essential to decrease mortality associated with this condition. This activity reviews the evaluation and management of resistant hypercalcemia and highlights the role of the healthcare team in managing patients with this condition. […] Resistant hypercalcemia can be defined as persistently elevated calcium levels despite multiple therapy modalities or if re-administration is required within two weeks of initial therapy. […] Adequate hydration and fluid resuscitation are essential in every patient presenting with severe hypercalcemia.

• #3 Hypercalcemia Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/hypercalcemia

  Most causes of hypercalcemia cannot be prevented. Anyone with symptoms of hypercalcemia should have their blood calcium level checked. […] Talk to your provider about the correct dose if you are taking calcium and vitamin D supplements.

• #4 Hypercalcemia (Elevated Calcium Levels) Symptoms & Treatment

  https://www.medicinenet.com/hypercalcemia/article.htm

  Is it possible to prevent hypercalcemia? Hypercalcemia cannot be prevented, but early detection can allow for the normalization of calcium levels and lead to an early work-up to define the cause. If there is a known family history of hypercalcemia or hyperparathyroidism, it is worth mentioning this to the healthcare practitioner; together the patient and healthcare practitioner can determine if screening is warranted.

• #5 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Not all cases of hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets can help. […] Be sure to talk with your healthcare provider if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your provider.

• #6 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Not all cases of hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets can help. […] Be sure to talk with your healthcare provider if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your provider.

• #7 Hypercalcemia Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/hypercalcemia

  Most causes of hypercalcemia cannot be prevented. Anyone with symptoms of hypercalcemia should have their blood calcium level checked. […] Talk to your provider about the correct dose if you are taking calcium and vitamin D supplements.

• #8 Hypercalcemia: High calcium levels and what to do

  https://www.medicalnewstoday.com/articles/322012

  Certain lifestyle adjustments can help keep calcium levels balanced and bones healthy. These include: […] Drinking plenty of water: Staying hydrated may lower blood calcium levels, and it can help prevent kidney stones. […] Quitting smoking, if applicable: Smoking can increase bone loss. In addition to improving the health of the bones, quitting will reduce the risk of cancer and other health problems. […] Exercising, including strength training: Resistance training promotes bone strength and health. […] Following guidelines for medications and supplements: Following medical advice may decrease the risk of consuming too much vitamin D and developing hypercalcemia.

• #9 Hypercalcemia: High calcium levels and what to do

  https://www.medicalnewstoday.com/articles/322012

  Certain lifestyle adjustments can help keep calcium levels balanced and bones healthy. These include: […] Drinking plenty of water: Staying hydrated may lower blood calcium levels, and it can help prevent kidney stones. […] Quitting smoking, if applicable: Smoking can increase bone loss. In addition to improving the health of the bones, quitting will reduce the risk of cancer and other health problems. […] Exercising, including strength training: Resistance training promotes bone strength and health. […] Following guidelines for medications and supplements: Following medical advice may decrease the risk of consuming too much vitamin D and developing hypercalcemia.

• #10 Hypercalcemia: High calcium levels and what to do

  https://www.medicalnewstoday.com/articles/322012

  Certain lifestyle adjustments can help keep calcium levels balanced and bones healthy. These include: […] Drinking plenty of water: Staying hydrated may lower blood calcium levels, and it can help prevent kidney stones. […] Quitting smoking, if applicable: Smoking can increase bone loss. In addition to improving the health of the bones, quitting will reduce the risk of cancer and other health problems. […] Exercising, including strength training: Resistance training promotes bone strength and health. […] Following guidelines for medications and supplements: Following medical advice may decrease the risk of consuming too much vitamin D and developing hypercalcemia.

• #11 What to Know About Hypercalcemia

  https://www.webmd.com/a-to-z-guides/hypercalcemia-what-to-know

  If you have hypercalcemia, your outlook will depend on how severe your condition is and whats causing it. If its mild, you may not have other health complications. You can follow your doctors recommendations and take the steps needed to manage and monitor your calcium levels. […] While its not possible to prevent hypercalcemia if it stems from another medical condition such as cancer, you can take some steps to manage your blood calcium levels. […] You can: […] Tell your doctor about any family history of hyperparathyroidism, kidney stones, or high blood calcium. This can help them monitor and catch your hypercalcemia early. […] Avoid taking calcium-rich supplements or antacids without consulting your doctor first. […] Check with your doctor before taking any dietary supplements, vitamins, or minerals.

• #12 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Not all cases of hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets can help. […] Be sure to talk with your healthcare provider if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your provider.

• #13 What to Know About Hypercalcemia

  https://www.webmd.com/a-to-z-guides/hypercalcemia-what-to-know

  If you have hypercalcemia, your outlook will depend on how severe your condition is and whats causing it. If its mild, you may not have other health complications. You can follow your doctors recommendations and take the steps needed to manage and monitor your calcium levels. […] While its not possible to prevent hypercalcemia if it stems from another medical condition such as cancer, you can take some steps to manage your blood calcium levels. […] You can: […] Tell your doctor about any family history of hyperparathyroidism, kidney stones, or high blood calcium. This can help them monitor and catch your hypercalcemia early. […] Avoid taking calcium-rich supplements or antacids without consulting your doctor first. […] Check with your doctor before taking any dietary supplements, vitamins, or minerals.

• #14 Hypercalcaemia | Endocrine Conditions

  https://www.yourhormones.info/endocrine-conditions/hypercalcaemia/

  Management of hypercalcaemia depends on the patients physical state, including levels of hydration, mental state, the severity of the hypercalcaemia and the results of a kidney function test. It also depends on the cause of the hypercalcaemia. […] If hypercalcaemia is caused by primary hyperparathyroidism, it is important to treat this condition in order to improve symptoms and prevent long-term problems such as osteoporosis or kidney stones. Primary hyperparathyroidism requires an early specialist opinion to determine if symptoms are related to the hyperparathyroidism. Expertise is required to identify whether a parathyroid swelling (adenoma) is present before surgical removal. If an adenoma is identified, the aims of surgical removal are reversal of symptoms, prevention of long-term complications and normalisation of calcium levels. In patients where an operation is not possible, specialist medication may be needed to lower parathyroid hormone levels.

• #15 Hypercalcemia – USZ

  https://www.usz.ch/en/disease/hypercalcemia/

  There are no known specific measures you can take to prevent hypercalcemia. However, you should always ensure an adequate supply of calcium, because there is also the opposite: hypocalcemia, an undersupply of calcium. So its a matter of finding the right balance. […] The most common causes of hypercalcemia are cancer and hyperparathyroidism an overactive parathyroid gland. If they are taking vitamin D and calcium supplements, they should have their calcium levels checked regularly by a health care professional. […] There are also no special measures for early detection of hypercalcemia. The determination of calcium levels in blood serum is not a routine examination in healthy people. However, in affected individuals with an existing disease, we usually determine the values alongside other blood values. Be sure to come to us if you experience symptoms such as fatigue, loss of appetite, nausea, vomiting, constipation or abdominal pain.

• #16

  https://journals.lww.com/cjasn/fulltext/2012/10000/onco_nephrology__the_pathophysiology_and_treatment.25.aspx

  Hypercalcemia complicates the course of 10%30% of all patients with malignancies and can be a sign of very poor prognosis and advanced malignancy. […] The mainstays of therapy for hypercalcemia are aggressive intravenous volume expansion with saline, bisphosphonate therapy, and perhaps loop diuretics. […] In refractory cases, gallium nitrate and perhaps denosumab are alternatives. […] In patients presenting with severe AKI, hemodialysis with a low-calcium bath can be effective. […] In most cases, therapy normalizes calcium levels and allows for palliation or curative therapy of the malignancy.

• #17 Take a look at the Recent articles

  https://www.oatext.com/Management-of-hypercalcemia-of-malignancy.php

  Malignancy is one of the most common causes of hypercalcemia, particularly in cancer associated with bone metastases. Hypercalcemia occurs in up to 20% to 30% of cancer patients at some time during the course of their disease. […] Fluids are first-line treatment with hypercalcemia followed by bisphosphanates if the calcium is high and the patient is experiencing symptoms. Various other medications are used as second-line agents in hypercalcemia of malignancy. […] The optimal therapy for hypercalcemia of malignancy is dependent on the severity of hypercalcemia and underlying causes. Hypercalcemia associated with malignancy would be resolved with definitive antitumor therapy of the underlying cancer with chemotherapy. […] Asymptomatic patients with mild hypercalcemia (serum Ca level of 10.5 to 12 mg/dL) generally do not require immediate treatment.

• #18 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Hypercalcemia is defined as a condition in which the serum calcium level is 10.5 mg/dL (the upper limit of normal) or the ionized calcium level exceeds 5.6 mg/dL. […] Hypercalcemia related to malignancy may resolve with definitive antitumor therapy directed at the underlying cancer, such as surgery or chemotherapy. […] If it does not resolve with appropriate anticancer treatment, antihypercalcemic therapy focusing on targeting the pathophysiologic mechanisms should be considered. […] Asymptomatic patients with mild hypercalcemia (serum calcium level, 10.5-12 mg/dL) generally do not require immediate treatment. […] Symptomatic patients whose serum calcium level exceeds 12 mg/dL or asymptomatic persons whose level exceeds 14 mg/dL should be immediately and aggressively treated with antihypercalcemic therapy: saline rehydration followed by loop diuretics, calcitonin, bisphosphonates, or denosumab.

• #19 Hypercalcemia

  https://www.texasoncology.com/types-of-cancer/bone-cancer/hypercalcemia

  The best treatment for hypercalcemia due to cancer is treatment of the cancer itself. However, since hypercalcemia often occurs in patients whose cancer is advanced or has not responded to treatment, management of hypercalcemia is sometimes necessary. […] Treatment for hypercalcemia is based on a number of factors, including the condition of the patient and the severity of the hypercalcemia. Increasing fluid intake and the use of diuretics has been standard practice. Most recently, bisphosphonate drugs have become an effective approach. […] One of the primary treatments for hypercalcemia of malignancy is hydration, which may consist of increasing oral fluid intake or intravenous (through a vein) administration of fluids. Hydration helps decrease the calcium level through dilution and causes the body to eliminate excess calcium through the urine.

• #20 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Hypercalcemia is defined as a condition in which the serum calcium level is 10.5 mg/dL (the upper limit of normal) or the ionized calcium level exceeds 5.6 mg/dL. […] Hypercalcemia related to malignancy may resolve with definitive antitumor therapy directed at the underlying cancer, such as surgery or chemotherapy. […] If it does not resolve with appropriate anticancer treatment, antihypercalcemic therapy focusing on targeting the pathophysiologic mechanisms should be considered. […] Asymptomatic patients with mild hypercalcemia (serum calcium level, 10.5-12 mg/dL) generally do not require immediate treatment. […] Symptomatic patients whose serum calcium level exceeds 12 mg/dL or asymptomatic persons whose level exceeds 14 mg/dL should be immediately and aggressively treated with antihypercalcemic therapy: saline rehydration followed by loop diuretics, calcitonin, bisphosphonates, or denosumab.

• #21 A Simplified Approach to the Management of Hypercalcemia

  https://openurologyandnephrologyjournal.com/VOLUME/11/PAGE/22/

  While patients with hypercalcemia can be treated with various treatment options including volume expansion, loop diuretics, calcitonin, bisphosphonate, sensipar; hypercalcemia can be resistant to these measures. […] In order to reduce morbidity and mortality, its diagnosis must be established earlier on. […] Patients with hypercalcemia can be treated with various treatment options including aggressive volume expansion (usually 1 to 2 L normal saline bolus followed by maintenance fluids at 100 to 150 mL/hour with a goal of urine output of 100 mL/hour and a decrease in serum calcium of 2 mg/dl/24 hours), loop diuretics (to excrete calcium) and calcitonin and bisphosphonate (to inhibit osteoclastic bone resorption). […] Due to its ability to control hypercalcemia and safety profile, bisphosphonates are the standard of care in the treatment of cancer-associated hypercalcemia.

• #22 Hypercalcemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hypercalcemia

  The 2022 guideline on management of hypercalcemia of malignancy: […] Emphasizes controlling hypercalcemia and preventing its recurrence. […] In adults with hypercalcemia of malignancy (HCM), we recommend treatment with an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) compared with management without an IV BP or Dmab. […] In adults with hypercalcemia of malignancy (HCM), we suggest treatment with denosumab (Dmab) over an intravenous (IV) bisphosphonate (BP). […] In adults with severe hypercalcemia of malignancy (HCM) (serum calcium [SCa]14 mg/dL [3.5 mmol/L]), we suggest a combination of calcitonin and an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) as initial treatment, compared with only IV BP or Dmab. […] In adults with refractory/recurrent hypercalcemia of malignancy (HCM) on an intravenous (IV) bisphosphonate (BP), we suggest the use of denosumab (Dmab), compared with management without Dmab.

• #23 Hypercalcemia | MedLink Neurology

  https://www.medlink.com/articles/hypercalcemia

  The methods for prevention of hypercalcemia depend on the underlying disorder. […] Only some causes of hypercalcemia are preventable (eg, vitamin D and A intoxication). […] Intravenous bisphosphonates are effective in reducing the incidence of hypercalcemia in patients with breast cancer and known skeletal metastases. […] The methods for preventing hypercalcemia depend on the underlying disorder. Some causes are not preventable (eg, primary hyperparathyroidism, cancer, sarcoidosis), whereas others clearly are (eg, vitamin D and A intoxication). Intravenous bisphosphonates have been shown to be effective in reducing the incidence of hypercalcemia in patients with breast cancer and known skeletal metastases.

• #24 Hypercalcemia

  https://www.texasoncology.com/types-of-cancer/bone-cancer/hypercalcemia

  Sometimes, hypercalcemia of malignancy is treated with a diuretic. The most commonly used diuretic, furosemide (Lasix), causes the kidneys to produce more urine. […] Bisphosphonate drugs can effectively prevent loss of bone that occurs from metastatic lesions, reduce the risk of fractures, and decrease pain. Bisphosphonate drugs work by inhibiting bone resorption, or breakdown. […] Bisphosphonate drugs that are FDA-approved for the treatment of hypercalcemia include Zometa (zoledronic acid) and Aredia (pamidronate).

• #25 Hypercalcemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hypercalcemia

  The 2022 guideline on management of hypercalcemia of malignancy: […] Emphasizes controlling hypercalcemia and preventing its recurrence. […] In adults with hypercalcemia of malignancy (HCM), we recommend treatment with an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) compared with management without an IV BP or Dmab. […] In adults with hypercalcemia of malignancy (HCM), we suggest treatment with denosumab (Dmab) over an intravenous (IV) bisphosphonate (BP). […] In adults with severe hypercalcemia of malignancy (HCM) (serum calcium [SCa]14 mg/dL [3.5 mmol/L]), we suggest a combination of calcitonin and an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) as initial treatment, compared with only IV BP or Dmab. […] In adults with refractory/recurrent hypercalcemia of malignancy (HCM) on an intravenous (IV) bisphosphonate (BP), we suggest the use of denosumab (Dmab), compared with management without Dmab.

• #26 Denosumab for First-Line Treatment of Hypercalcemia Associated with Malignancy: Retrospective Analysis

  https://www.jhoponline.com/issue-archive/2021-issues/june-2021-vol-11-no-3/18933:denosumab-for-first-line-treatment-of-hypercalcemia-associated-with-malignancy-retrospective-analysis

  Denosumab may be effective as a first-line treatment for hypercalcemia associated with malignancy. Our findings support the use of denosumab as a first-line treatment of hypercalcemia of malignancy. Denosumab can achieve response rates that are comparable to standard treatment with intravenous bisphosphonates. […] Denosumab is currently approved by the FDA for the treatment of bisphosphonate-refractory hypercalcemia associated with malignancy based on a single-arm, open-label study that included 33 patients with malignancy-related hypercalcemia refractory to IV bisphosphonates. […] Denosumab’s efficacy in the second-line therapy setting provides a rationale to consider denosumab in the front-line treatment setting for patients with malignancy-related hypercalcemia. […] Our characterization of denosumab for the treatment of hypercalcemia associated with cancer supports its use as a convenient strategy with favorable safety and efficacy profiles. Our findings suggest that single-dose denosumab is effective for the first-line treatment of hypercalcemia of malignancy when outpatient management is appropriate.

• #27 High calcium levels and cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/blood-calcium/high-calcium-people-cancer

  Cancer that has spread (advanced cancer) can cause high calcium levels. It is not really possible to prevent it from happening. It is not caused by anything in your diet so you shouldn’t need to alter what you eat. […] Recognising the symptoms of high blood calcium is important so that you can ask your doctor for help as soon as possible.

• #28 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. […] An initial diagnostic work-up should include measurement of intact parathyroid hormone, and any medications that are likely to be causative should be discontinued. […] It is essential to exclude other causes before considering parathyroid surgery, and patients should be referred for parathyroidectomy only if they meet certain criteria. […] Many patients with primary hyperparathyroidism have a benign course and do not need surgery. […] The principal challenges in the management of hypercalcemia are distinguishing primary hyperparathyroidism from conditions that will not respond to parathyroidectomy and knowing when it is appropriate to refer the patient for surgery. […] It is essential that physicians know how to evaluate and optimally manage patients with hypercalcemia, because treatment and prognosis vary according to the underlying disorder.

• #29 Hyperparathyroidism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism

  Managing underlying conditions, like chronic kidney disease, can reduce your risk of secondary hyperparathyroidism. There arent specific ways to reduce your risk of primary hyperparathyroidism. […] If you have hyperparathyroidism and dont have surgery, youll need to monitor your symptoms. You might also need to make changes to what you eat or take medications or supplements. […] For some people with hyperparathyroidism and low vitamin D levels, it might make sense to take vitamin D supplements. Always ask your provider what kinds of foods, beverages and supplements you should be looking for and what you should avoid.

• #30 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. […] An initial diagnostic work-up should include measurement of intact parathyroid hormone, and any medications that are likely to be causative should be discontinued. […] It is essential to exclude other causes before considering parathyroid surgery, and patients should be referred for parathyroidectomy only if they meet certain criteria. […] Many patients with primary hyperparathyroidism have a benign course and do not need surgery. […] The principal challenges in the management of hypercalcemia are distinguishing primary hyperparathyroidism from conditions that will not respond to parathyroidectomy and knowing when it is appropriate to refer the patient for surgery. […] It is essential that physicians know how to evaluate and optimally manage patients with hypercalcemia, because treatment and prognosis vary according to the underlying disorder.

• #31 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. […] An initial diagnostic work-up should include measurement of intact parathyroid hormone, and any medications that are likely to be causative should be discontinued. […] It is essential to exclude other causes before considering parathyroid surgery, and patients should be referred for parathyroidectomy only if they meet certain criteria. […] Many patients with primary hyperparathyroidism have a benign course and do not need surgery. […] The principal challenges in the management of hypercalcemia are distinguishing primary hyperparathyroidism from conditions that will not respond to parathyroidectomy and knowing when it is appropriate to refer the patient for surgery. […] It is essential that physicians know how to evaluate and optimally manage patients with hypercalcemia, because treatment and prognosis vary according to the underlying disorder.

• #32 Hyperparathyroidism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism

  Managing underlying conditions, like chronic kidney disease, can reduce your risk of secondary hyperparathyroidism. There arent specific ways to reduce your risk of primary hyperparathyroidism. […] If you have hyperparathyroidism and dont have surgery, youll need to monitor your symptoms. You might also need to make changes to what you eat or take medications or supplements. […] For some people with hyperparathyroidism and low vitamin D levels, it might make sense to take vitamin D supplements. Always ask your provider what kinds of foods, beverages and supplements you should be looking for and what you should avoid.

• #33 Lithium induced hypercalcemia: an expert opinion and management algorithm | International Journal of Bipolar Disorders | Full Text

  https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00283-3

  Lithium is the gold standard prophylactic treatment for bipolar disorder. Most clinical practice guidelines recommend regular calcium assessments as part of monitoring lithium treatment, but easy-to-implement specific management strategies in the event of abnormal calcium levels are lacking. […] To facilitate the safe use of lithium and to prevent clinicians from avoiding using lithium when clinically indicated due to uncertainties about how to practically manage side-effects, clinical guidelines for treatment management are needed. […] A standardized plan across clinical practices for the early management of abnormalities of calcium and PTH plasma levels is lacking. This situation led to the following algorithm being developed in collaboration with specialists trained in psychiatry and endocrinology.

• #34 Lithium induced hypercalcemia: an expert opinion and management algorithm | International Journal of Bipolar Disorders | Full Text

  https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00283-3

  Lithium is the gold standard prophylactic treatment for bipolar disorder. Most clinical practice guidelines recommend regular calcium assessments as part of monitoring lithium treatment, but easy-to-implement specific management strategies in the event of abnormal calcium levels are lacking. […] To facilitate the safe use of lithium and to prevent clinicians from avoiding using lithium when clinically indicated due to uncertainties about how to practically manage side-effects, clinical guidelines for treatment management are needed. […] A standardized plan across clinical practices for the early management of abnormalities of calcium and PTH plasma levels is lacking. This situation led to the following algorithm being developed in collaboration with specialists trained in psychiatry and endocrinology.

• #35 Lithium induced hypercalcemia: an expert opinion and management algorithm | International Journal of Bipolar Disorders | Full Text

  https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00283-3

  Lithium is the gold standard prophylactic treatment for bipolar disorder. Most clinical practice guidelines recommend regular calcium assessments as part of monitoring lithium treatment, but easy-to-implement specific management strategies in the event of abnormal calcium levels are lacking. […] To facilitate the safe use of lithium and to prevent clinicians from avoiding using lithium when clinically indicated due to uncertainties about how to practically manage side-effects, clinical guidelines for treatment management are needed. […] A standardized plan across clinical practices for the early management of abnormalities of calcium and PTH plasma levels is lacking. This situation led to the following algorithm being developed in collaboration with specialists trained in psychiatry and endocrinology.

• #36 Lithium induced hypercalcemia: an expert opinion and management algorithm | International Journal of Bipolar Disorders | Full Text

  https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00283-3

  Abnormalities in plasma calcium and PTH levels homeostasis are frequently seen in patients treated with lithium, but a standardized and practical approach guiding clinicians on how to monitor and manage the abnormalities and their causes in the psychiatric setting are hitherto lacking. Here we present an evidence-based consensus driven management algorithm intended to provide a helpful tool for clinicians monitoring long-term lithium treatment. Besides assuring the detection and proper handling of relevant calcium abnormalities, the algorithm will likely diminish the potential risk of premature discontinuation of lithium treatment in patients who benefit from lithium, due to treatment emergent hypercalcemia. Finally, the algorithm may reduce the risk of clinicians avoiding the use of lithium in patients who would otherwise benefit due to uncertainties about management of this potential often treatable side effect.

• #37 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Hypercalcemia is a serum calcium (Ca) level over two standard deviations above the average mean values. That equates to a total serum calcium level greater than 10.5 mg/dl or an ionized calcium level greater than 5.3 mg/dl. […] Early recognition and prompt diagnosis are essential to decrease mortality associated with this condition. This activity reviews the evaluation and management of resistant hypercalcemia and highlights the role of the healthcare team in managing patients with this condition. […] Resistant hypercalcemia can be defined as persistently elevated calcium levels despite multiple therapy modalities or if re-administration is required within two weeks of initial therapy. […] Adequate hydration and fluid resuscitation are essential in every patient presenting with severe hypercalcemia.

• #38 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Hypercalcemia is a serum calcium (Ca) level over two standard deviations above the average mean values. That equates to a total serum calcium level greater than 10.5 mg/dl or an ionized calcium level greater than 5.3 mg/dl. […] Early recognition and prompt diagnosis are essential to decrease mortality associated with this condition. This activity reviews the evaluation and management of resistant hypercalcemia and highlights the role of the healthcare team in managing patients with this condition. […] Resistant hypercalcemia can be defined as persistently elevated calcium levels despite multiple therapy modalities or if re-administration is required within two weeks of initial therapy. […] Adequate hydration and fluid resuscitation are essential in every patient presenting with severe hypercalcemia.

• #39 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Antiresorptive agents have proven to be effective in the management of resistant hypercalcemia. […] The mainstays of therapy include volume resuscitation, bisphosphonates, and calcitonin. However, despite preliminary treatment, denosumab has been proven to be an excellent choice of therapy in resistant hypercalcemia cases. […] The importance of the interprofessional approach cannot be under-emphasized. Early identification of symptomatic hypercalcemia by the emergency medicine physician is essential to initiate immediate hydration. […] Patients should be made aware of the mortality associated with severe hypercalcemia. Also, all available treatment options, including hemodialysis or parathyroidectomy, should be discussed, especially in cases of persistent/ resistant hypercalcemia.

• #40 A Simplified Approach to the Management of Hypercalcemia

  https://openurologyandnephrologyjournal.com/VOLUME/11/PAGE/22/FULLTEXT/

  The anti-PTH related peptide antibodies (Denosumab) are approved for hypercalcemia and are helpful in the management of bisphosphonate refractory hypercalcemia. […] Selective Percutaneous Ethanol Injection Therapy (PEIT) guided by color Doppler flow mapping is an effective and safe adjunct to medical therapy with a low risk for hypoparathyroidism, which is a viable option and has been well described in literature. […] Though the result of PEIT is promising, it is also necessary to evaluate the result of parathyroidectomy following PEIT, the time for the development of adhesion after PEIT and the number of times PEIT can be repeated before the adhesions become too severe. […] Hypercalcemia can be life threatening and requires immediate intervention. While traditional measures of controlling hypercalcemia are effective, primary hyperparathyroidism can be resistant. Surgical removal of the gland is the definitive therapy for these patients. However, not everyone is a surgical candidate. In such patient minimally invasive direct ethanol injection is a viable option.

• #41 Denosumab in the treatment of hypercalcemia secondary to malignancy | ODRR

  https://www.dovepress.com/denosumab-in-the-treatment-of-hypercalcemia-secondary-to-malignancy-peer-reviewed-fulltext-article-ODRR

  Denosumab, a potent antiresorptive agent, appears to have promise as an additional tool in the armament of treatment for patients with sustained hypercalcemia. […] Denosumab can be employed in the face of either renal or hepatic dysfunction in contrast to the intravenous bisphosphonates and thereby expanding the range of potentially treated individuals. […] Although there remains no set regimen that is generally effective, repeated doses can be given at regular intervals.

• #42 A Simplified Approach to the Management of Hypercalcemia

  https://openurologyandnephrologyjournal.com/VOLUME/11/PAGE/22/

  The anti-PTH related peptide antibodies (Denosumab) are approved for hypercalcemia and are helpful in the management of bisphosphonate refractory hypercalcemia. […] Management of hypercalcemia is outlined in Fig. […] Severe hypercalcemia (serum calcium of 18mg/dL) that is refractory to the traditional measures may require dialysis. […] Hemodialysis with low calcium bath can be very helpful to lower serum calcium quickly. […] Selective Percutaneous Ethanol Injection Therapy (PEIT) guided by color Doppler flow mapping is an effective and safe adjunct to medical therapy with a low risk for hypoparathyroidism, which is a viable option and has been well described in literature. […] The patients who are resistant to medical therapy and are considered as high risk surgical candidates could be managed successfully by PEIT.

• #43 A Simplified Approach to the Management of Hypercalcemia

  https://openurologyandnephrologyjournal.com/VOLUME/11/PAGE/22/

  The anti-PTH related peptide antibodies (Denosumab) are approved for hypercalcemia and are helpful in the management of bisphosphonate refractory hypercalcemia. […] Management of hypercalcemia is outlined in Fig. […] Severe hypercalcemia (serum calcium of 18mg/dL) that is refractory to the traditional measures may require dialysis. […] Hemodialysis with low calcium bath can be very helpful to lower serum calcium quickly. […] Selective Percutaneous Ethanol Injection Therapy (PEIT) guided by color Doppler flow mapping is an effective and safe adjunct to medical therapy with a low risk for hypoparathyroidism, which is a viable option and has been well described in literature. […] The patients who are resistant to medical therapy and are considered as high risk surgical candidates could be managed successfully by PEIT.

• #44 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  For the majority of cancer patients with HHM or local osteolytic hypercalcemia, intravenous bisphosphonates or subcutaneous/intramuscular calcitonin or subcutaneous denosumab can be used to inhibit osteoclast-mediated bone resorption. […] The cornerstone of initial treatment of hypercalcemia in these patients is volume expansion with intravenous normal saline to increase the glomerular filtration rate and renal calcium excretion. […] Once intravascular volume has been restored, low-dose furosemide (20-40 mg intravenously) every 1 to 4 hours can be used to further lower the serum calcium level and/or prevent the development of volume overload from administration of normal saline. […] Bisphosphonate therapy should be initiated as soon as hypercalcemia is detected, because it takes 2 to 4 days to lower the calcium level.

• #45 Hypercalcemia

  https://www.texasoncology.com/types-of-cancer/bone-cancer/hypercalcemia

  Sometimes, hypercalcemia of malignancy is treated with a diuretic. The most commonly used diuretic, furosemide (Lasix), causes the kidneys to produce more urine. […] Bisphosphonate drugs can effectively prevent loss of bone that occurs from metastatic lesions, reduce the risk of fractures, and decrease pain. Bisphosphonate drugs work by inhibiting bone resorption, or breakdown. […] Bisphosphonate drugs that are FDA-approved for the treatment of hypercalcemia include Zometa (zoledronic acid) and Aredia (pamidronate).

• #46 Hypercalcemia

  https://www.texasoncology.com/types-of-cancer/bone-cancer/hypercalcemia

  Sometimes, hypercalcemia of malignancy is treated with a diuretic. The most commonly used diuretic, furosemide (Lasix), causes the kidneys to produce more urine. […] Bisphosphonate drugs can effectively prevent loss of bone that occurs from metastatic lesions, reduce the risk of fractures, and decrease pain. Bisphosphonate drugs work by inhibiting bone resorption, or breakdown. […] Bisphosphonate drugs that are FDA-approved for the treatment of hypercalcemia include Zometa (zoledronic acid) and Aredia (pamidronate).

• #47 Hypercalcemia

  https://www.texasoncology.com/types-of-cancer/bone-cancer/hypercalcemia

  Sometimes, hypercalcemia of malignancy is treated with a diuretic. The most commonly used diuretic, furosemide (Lasix), causes the kidneys to produce more urine. […] Bisphosphonate drugs can effectively prevent loss of bone that occurs from metastatic lesions, reduce the risk of fractures, and decrease pain. Bisphosphonate drugs work by inhibiting bone resorption, or breakdown. […] Bisphosphonate drugs that are FDA-approved for the treatment of hypercalcemia include Zometa (zoledronic acid) and Aredia (pamidronate).

• #48 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  For the majority of cancer patients with HHM or local osteolytic hypercalcemia, intravenous bisphosphonates or subcutaneous/intramuscular calcitonin or subcutaneous denosumab can be used to inhibit osteoclast-mediated bone resorption. […] The cornerstone of initial treatment of hypercalcemia in these patients is volume expansion with intravenous normal saline to increase the glomerular filtration rate and renal calcium excretion. […] Once intravascular volume has been restored, low-dose furosemide (20-40 mg intravenously) every 1 to 4 hours can be used to further lower the serum calcium level and/or prevent the development of volume overload from administration of normal saline. […] Bisphosphonate therapy should be initiated as soon as hypercalcemia is detected, because it takes 2 to 4 days to lower the calcium level.

• #49 A Simplified Approach to the Management of Hypercalcemia

  https://openurologyandnephrologyjournal.com/VOLUME/11/PAGE/22/FULLTEXT/

  While patients with hypercalcemia can be treated with various treatment options including volume expansion, loop diuretics, calcitonin, bisphosphonate, sensipar; hypercalcemia can be resistant to these measures. […] In order to reduce morbidity and mortality, its diagnosis must be established earlier on. […] Patients with hypercalcemia can be treated with various treatment options including aggressive volume expansion (usually 1 to 2 L normal saline bolus followed by maintenance fluids at 100 to 150 mL/hour with a goal of urine output of 100 mL/hour and a decrease in serum calcium of 2 mg/dl/24 hours), loop diuretics (to excrete calcium) and calcitonin and bisphosphonate (to inhibit osteoclastic bone resorption). […] Due to its ability to control hypercalcemia and safety profile, bisphosphonates are the standard of care in the treatment of cancer-associated hypercalcemia.

• #50 Hypercalcaemia of malignancy (HCM)

  https://www.eviq.org.au/clinical-resources/oncological-emergencies/486-hypercalcaemia-of-malignancy-hcm

  Bisphosphonates can cause nephrotoxicity, adequate hydration can enhance renal protection. […] Denosumab is a RANKL monoclonal antibody which inhibits osteoclast activation and function. […] Calcitonin blocks osteoclast activity and also renal tubular reabsorption of calcium. […] Corticosteroids can be given, but may only be useful where hypercalcaemia is due to sarcoidosis, lymphoma or vitamin D intoxication or multiple myeloma.

• #51 Denosumab for management of severe hypercalcemia in primary hyperparathyroidism in: Endocrine Connections Volume 9 Issue 10 (2020)

  https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0380.xml

  Hypercalcemic crisis is a severe but rare complication of primary hyperparathyroidism (PHPT), and data on denosumab treatment of patients with this disease is still very limited. […] The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia when surgery should be delayed or is impossible for some reasons. […] Our study shows that denosumab is a useful tool in PHPT-associated hypercalcemia before surgery or if surgery is contraindicated. […] The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia then surgery should be delayed or is impossible for some reasons. […] Denosumab binds RANKL with high affinity and specificity, preventing interaction with RANK on the osteoclast membrane.

• #52 Denosumab for First-Line Treatment of Hypercalcemia Associated with Malignancy: Retrospective Analysis

  https://www.jhoponline.com/issue-archive/2021-issues/june-2021-vol-11-no-3/18933:denosumab-for-first-line-treatment-of-hypercalcemia-associated-with-malignancy-retrospective-analysis

  Denosumab may be effective as a first-line treatment for hypercalcemia associated with malignancy. Our findings support the use of denosumab as a first-line treatment of hypercalcemia of malignancy. Denosumab can achieve response rates that are comparable to standard treatment with intravenous bisphosphonates. […] Denosumab is currently approved by the FDA for the treatment of bisphosphonate-refractory hypercalcemia associated with malignancy based on a single-arm, open-label study that included 33 patients with malignancy-related hypercalcemia refractory to IV bisphosphonates. […] Denosumab’s efficacy in the second-line therapy setting provides a rationale to consider denosumab in the front-line treatment setting for patients with malignancy-related hypercalcemia. […] Our characterization of denosumab for the treatment of hypercalcemia associated with cancer supports its use as a convenient strategy with favorable safety and efficacy profiles. Our findings suggest that single-dose denosumab is effective for the first-line treatment of hypercalcemia of malignancy when outpatient management is appropriate.

• #53 University of Illinois Chicago

  https://dig.pharmacy.uic.edu/faqs/2019-2/november-2019-faqs/what-criteria-exist-to-suggest-use-of-denosumab-for-the-treatment-of-hypercalcemia-of-malignancy-over-other-calcium-reducing-options/

  Denosumab is approved for the prevention of skeletal related events (eg, spinal cord compression, fractures) in adults with bone metastases from solid tumors or multiple myeloma, treatment of giant cell tumor of bone that is unresectable, and treatment of HCM refractory to bisphosphonate therapy. […] Overall, the evidence for denosumab in the treatment and prevention of HCM is limited. […] Denosumab was more efficacious than ZA in delaying or preventing HCM in patients with advanced cancer and bone metastases or with multiple myeloma. […] Currently, denosumab is recommended in patients refractory to bisphosphonates or where bisphosphonate therapy may be contraindicated (eg, renal impairment). […] At this time, there are no published criteria for choosing denosumab over other agents for management of hypercalcemia. […] These criteria may be an important tool for institutions to consider when developing guidelines for use.

• #54 Denosumab for management of severe hypercalcemia in primary hyperparathyroidism in: Endocrine Connections Volume 9 Issue 10 (2020)

  https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0380.xml

  Hypercalcemic crisis is a severe but rare complication of primary hyperparathyroidism (PHPT), and data on denosumab treatment of patients with this disease is still very limited. […] The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia when surgery should be delayed or is impossible for some reasons. […] Our study shows that denosumab is a useful tool in PHPT-associated hypercalcemia before surgery or if surgery is contraindicated. […] The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia then surgery should be delayed or is impossible for some reasons. […] Denosumab binds RANKL with high affinity and specificity, preventing interaction with RANK on the osteoclast membrane.

• #55 Denosumab for management of severe hypercalcemia in primary hyperparathyroidism in: Endocrine Connections Volume 9 Issue 10 (2020)

  https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0380.xml

  By blocking RANKL, denosumab inhibits osteoclast differentiation, activation and survival. This prevents bone resorption and thereby decreases blood calcium levels. […] The effect of denosumab on RANKL signaling, inhibition of PTH-driven bone resorption and associated reduction of serum calcium levels makes it a useful tool to control severe hypercalcemia in patients with PHPT before surgery or if surgery is contraindicated for some reasons.

• #56 Denosumab for management of severe hypercalcemia in primary hyperparathyroidism in: Endocrine Connections Volume 9 Issue 10 (2020)

  https://ec.bioscientifica.com/view/journals/ec/9/10/EC-20-0380.xml

  By blocking RANKL, denosumab inhibits osteoclast differentiation, activation and survival. This prevents bone resorption and thereby decreases blood calcium levels. […] The effect of denosumab on RANKL signaling, inhibition of PTH-driven bone resorption and associated reduction of serum calcium levels makes it a useful tool to control severe hypercalcemia in patients with PHPT before surgery or if surgery is contraindicated for some reasons.

• #57 Denosumab in the treatment of hypercalcemia secondary to malignancy | ODRR

  https://www.dovepress.com/denosumab-in-the-treatment-of-hypercalcemia-secondary-to-malignancy-peer-reviewed-fulltext-article-ODRR

  Denosumab, a potent antiresorptive agent, appears to have promise as an additional tool in the armament of treatment for patients with sustained hypercalcemia. […] Denosumab can be employed in the face of either renal or hepatic dysfunction in contrast to the intravenous bisphosphonates and thereby expanding the range of potentially treated individuals. […] Although there remains no set regimen that is generally effective, repeated doses can be given at regular intervals.

• #58 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Denosumab can be used to manage malignancy-associated hypercalcemia in patients with persistent hypercalcemia despite bisphosphonate treatment. […] Glucocorticoids are a treatment option for hypercalcemia in patients with excessive vitamin D or endogenous overproduction of calcitriol secondary to lymphoma. […] Calcitonin is an alternative to saline hydration therapy for patients who have severe chronic heart failure or moderate to severe renal dysfunction. […] Gallium nitrate is approved for treatment in hypercalcemia of malignancy. […] Mithramycin reduces serum calcium by inhibiting osteoclast-mediated bone resorption. […] Hypercalcemia is a common complication of cancer. Hydration is key, and bisphosphonates are the most popular first-line agents. Denosumab, although expensive, is a valid option for patients with renal impairment. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #59 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Denosumab can be used to manage malignancy-associated hypercalcemia in patients with persistent hypercalcemia despite bisphosphonate treatment. […] Glucocorticoids are a treatment option for hypercalcemia in patients with excessive vitamin D or endogenous overproduction of calcitriol secondary to lymphoma. […] Calcitonin is an alternative to saline hydration therapy for patients who have severe chronic heart failure or moderate to severe renal dysfunction. […] Gallium nitrate is approved for treatment in hypercalcemia of malignancy. […] Mithramycin reduces serum calcium by inhibiting osteoclast-mediated bone resorption. […] Hypercalcemia is a common complication of cancer. Hydration is key, and bisphosphonates are the most popular first-line agents. Denosumab, although expensive, is a valid option for patients with renal impairment. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #60 Hypercalcaemia of malignancy (HCM)

  https://www.eviq.org.au/clinical-resources/oncological-emergencies/486-hypercalcaemia-of-malignancy-hcm

  Bisphosphonates can cause nephrotoxicity, adequate hydration can enhance renal protection. […] Denosumab is a RANKL monoclonal antibody which inhibits osteoclast activation and function. […] Calcitonin blocks osteoclast activity and also renal tubular reabsorption of calcium. […] Corticosteroids can be given, but may only be useful where hypercalcaemia is due to sarcoidosis, lymphoma or vitamin D intoxication or multiple myeloma.

• #61 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Denosumab can be used to manage malignancy-associated hypercalcemia in patients with persistent hypercalcemia despite bisphosphonate treatment. […] Glucocorticoids are a treatment option for hypercalcemia in patients with excessive vitamin D or endogenous overproduction of calcitriol secondary to lymphoma. […] Calcitonin is an alternative to saline hydration therapy for patients who have severe chronic heart failure or moderate to severe renal dysfunction. […] Gallium nitrate is approved for treatment in hypercalcemia of malignancy. […] Mithramycin reduces serum calcium by inhibiting osteoclast-mediated bone resorption. […] Hypercalcemia is a common complication of cancer. Hydration is key, and bisphosphonates are the most popular first-line agents. Denosumab, although expensive, is a valid option for patients with renal impairment. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #62 Hypercalcaemia of malignancy (HCM)

  https://www.eviq.org.au/clinical-resources/oncological-emergencies/486-hypercalcaemia-of-malignancy-hcm

  Bisphosphonates can cause nephrotoxicity, adequate hydration can enhance renal protection. […] Denosumab is a RANKL monoclonal antibody which inhibits osteoclast activation and function. […] Calcitonin blocks osteoclast activity and also renal tubular reabsorption of calcium. […] Corticosteroids can be given, but may only be useful where hypercalcaemia is due to sarcoidosis, lymphoma or vitamin D intoxication or multiple myeloma.

• #63 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Denosumab can be used to manage malignancy-associated hypercalcemia in patients with persistent hypercalcemia despite bisphosphonate treatment. […] Glucocorticoids are a treatment option for hypercalcemia in patients with excessive vitamin D or endogenous overproduction of calcitriol secondary to lymphoma. […] Calcitonin is an alternative to saline hydration therapy for patients who have severe chronic heart failure or moderate to severe renal dysfunction. […] Gallium nitrate is approved for treatment in hypercalcemia of malignancy. […] Mithramycin reduces serum calcium by inhibiting osteoclast-mediated bone resorption. […] Hypercalcemia is a common complication of cancer. Hydration is key, and bisphosphonates are the most popular first-line agents. Denosumab, although expensive, is a valid option for patients with renal impairment. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #64 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Denosumab can be used to manage malignancy-associated hypercalcemia in patients with persistent hypercalcemia despite bisphosphonate treatment. […] Glucocorticoids are a treatment option for hypercalcemia in patients with excessive vitamin D or endogenous overproduction of calcitriol secondary to lymphoma. […] Calcitonin is an alternative to saline hydration therapy for patients who have severe chronic heart failure or moderate to severe renal dysfunction. […] Gallium nitrate is approved for treatment in hypercalcemia of malignancy. […] Mithramycin reduces serum calcium by inhibiting osteoclast-mediated bone resorption. […] Hypercalcemia is a common complication of cancer. Hydration is key, and bisphosphonates are the most popular first-line agents. Denosumab, although expensive, is a valid option for patients with renal impairment. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #65 Take a look at the Recent articles

  https://www.oatext.com/Management-of-hypercalcemia-of-malignancy.php

  After rehydration has been achieved, Loop diuretic, low-dose of furosemide can be used to prevent volume overload and to induce further renal calcium excretion. Intravenous bisphosphonates and subcutaneous denosumab can be used for severe hypercalcemia associated with cancer; those agents inhibit osteoclast activity and decrease bone resorption. […] There are several agents could be used as second-line option when bisphosphonates are ineffective or contraindicated. Glucocorticoid is not commonly used, but it is effective in hypercalcemia-induced by endogenous overproduction of calcitriol or excessive ingestion of vitamin D. […] Calcitonin is safe and nontoxic, and its serum calcium lowering effect is much faster than other agents. However, the efficacy of calcitonin is often erratic, and the duration of calcium lowering effect is relatively short. […] Mithramycin is not commonly used in hypercalcemia of malignancy due to its severe adverse effects. Finally, gallium nitrate is also approved for treatment, but the need of continuous IV infusion over 24 hours for 5 days limits its use in hypercalcemia of malignancy.

• #66 Hypercalcemia Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/hypercalcemia

  In adults with hypercalcemia of malignancy (HCM) from tumors associated with high calcitriol levels, such as lymphomas, who are already receiving glucocorticoid therapy but who continue to have severe or symptomatic hypercalcemia, we suggest the addition of an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) compared with management without an IV BP or Dmab. […] In adult patients with hypercalcemia of malignancy (HCM) due to parathyroid carcinoma, we suggest treatment with either a calcimimetic or an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab). […] In adult patients with hypercalcemia of malignancy (HCM) due to parathyroid carcinoma not adequately controlled despite treatment with a calcimimetic, we suggest the addition of an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) compared with management without an IV BP or Dmab. […] In adult patients with hypercalcemia of malignancy (HCM) due to parathyroid carcinoma who are not adequately controlled on an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) therapy, we suggest the addition of a calcimimetic compared with management without a calcimimetic.

• #67 Hypercalcemia Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/hypercalcemia

  Most causes of hypercalcemia cannot be prevented. Anyone with symptoms of hypercalcemia should have their blood calcium level checked. […] Talk to your provider about the correct dose if you are taking calcium and vitamin D supplements.

• #68 Hypercalcemia in Cats | PetMD

  https://www.petmd.com/cat/conditions/endocrine/hypercalcemia-cats

  Treatment for hypercalcemia depends upon the underlying cause. If a cause can be found and treated, then this should help to prevent future bouts of hypercalcemia. Also, cats showing signs of hypercalcemia and/or have a high calcium level require treatment to lower it. […] Most causes of hypercalcemia develop out of our control and cannot be prevented. The key is to keep your cat hydrated and bring your cat to your local veterinarian for a physical exam and bloodwork (which includes a calcium level check) every 6-12 months to allow for early detection.

• #69 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #70 High calcium levels and cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/blood-calcium/high-calcium-people-cancer

  Cancer that has spread (advanced cancer) can cause high calcium levels. It is not really possible to prevent it from happening. It is not caused by anything in your diet so you shouldn’t need to alter what you eat. […] Recognising the symptoms of high blood calcium is important so that you can ask your doctor for help as soon as possible.

• #71 Hypercalcemia (Elevated Calcium Levels) Symptoms & Treatment

  https://www.medicinenet.com/hypercalcemia/article.htm

  Is it possible to prevent hypercalcemia? Hypercalcemia cannot be prevented, but early detection can allow for the normalization of calcium levels and lead to an early work-up to define the cause. If there is a known family history of hypercalcemia or hyperparathyroidism, it is worth mentioning this to the healthcare practitioner; together the patient and healthcare practitioner can determine if screening is warranted.

• #72 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Antiresorptive agents have proven to be effective in the management of resistant hypercalcemia. […] The mainstays of therapy include volume resuscitation, bisphosphonates, and calcitonin. However, despite preliminary treatment, denosumab has been proven to be an excellent choice of therapy in resistant hypercalcemia cases. […] The importance of the interprofessional approach cannot be under-emphasized. Early identification of symptomatic hypercalcemia by the emergency medicine physician is essential to initiate immediate hydration. […] Patients should be made aware of the mortality associated with severe hypercalcemia. Also, all available treatment options, including hemodialysis or parathyroidectomy, should be discussed, especially in cases of persistent/ resistant hypercalcemia.

• #73 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #74 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #75 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #76 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #77 Hypercalcemia: What Is It, Symptoms, Causes and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/hypercalcemia

  Have a proper treatment for the health condition that is the cause of hypercalcemia. […] Take care of your health by drinking plenty of water and exercising. […] Consult with your doctor before taking calcium and vitamin D supplements.

• #78 Hypercalcemia: What Is It, Symptoms, Causes and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/hypercalcemia

  Have a proper treatment for the health condition that is the cause of hypercalcemia. […] Take care of your health by drinking plenty of water and exercising. […] Consult with your doctor before taking calcium and vitamin D supplements.

• #79 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #80 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #81 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #82 Hypercalcemia – discharge: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000044.htm

  You were treated in the hospital for hypercalcemia. Hypercalcemia means you have too much calcium in your blood. Now that you’re going home, you need to keep your calcium at a level as instructed by your health care provider. […] After you go home, follow your provider’s instructions about making sure your calcium level does not get high again. […] You will probably need to get blood tests after you go home. […] Keep any follow-up appointments you make with your provider. […] To further keep your calcium level from getting high again: […] If your provider prescribes medicines to help keep your calcium level from getting too high again, take them the way you’re told to. Contact your provider if you have any side effects. […] Stay active when you get home. Your provider will tell you how much activity and exercise are OK.

• #83 Hypercalcemia (High Calcium Level in the Blood) and Cancer

  https://johnshopkinshealthcare.staywellsolutionsonline.com/Library/PreventionGuidelines/34,18379-1

  You may be given calcium-controlling medicines or steroids. These are used to stop bone from breaking down and releasing calcium. […] You may have to take a hormone called calcitonin. It’s used to decrease calcium release from your bones and increase calcium removal in your kidneys. […] Tell your healthcare provider right away if you have any symptoms or symptoms of hypercalcemia that get worse.

• #84 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Antiresorptive agents have proven to be effective in the management of resistant hypercalcemia. […] The mainstays of therapy include volume resuscitation, bisphosphonates, and calcitonin. However, despite preliminary treatment, denosumab has been proven to be an excellent choice of therapy in resistant hypercalcemia cases. […] The importance of the interprofessional approach cannot be under-emphasized. Early identification of symptomatic hypercalcemia by the emergency medicine physician is essential to initiate immediate hydration. […] Patients should be made aware of the mortality associated with severe hypercalcemia. Also, all available treatment options, including hemodialysis or parathyroidectomy, should be discussed, especially in cases of persistent/ resistant hypercalcemia.

• #85 Lithium induced hypercalcemia: an expert opinion and management algorithm | International Journal of Bipolar Disorders | Full Text

  https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00283-3

  Abnormalities in plasma calcium and PTH levels homeostasis are frequently seen in patients treated with lithium, but a standardized and practical approach guiding clinicians on how to monitor and manage the abnormalities and their causes in the psychiatric setting are hitherto lacking. Here we present an evidence-based consensus driven management algorithm intended to provide a helpful tool for clinicians monitoring long-term lithium treatment. Besides assuring the detection and proper handling of relevant calcium abnormalities, the algorithm will likely diminish the potential risk of premature discontinuation of lithium treatment in patients who benefit from lithium, due to treatment emergent hypercalcemia. Finally, the algorithm may reduce the risk of clinicians avoiding the use of lithium in patients who would otherwise benefit due to uncertainties about management of this potential often treatable side effect.

• #86 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. […] An initial diagnostic work-up should include measurement of intact parathyroid hormone, and any medications that are likely to be causative should be discontinued. […] It is essential to exclude other causes before considering parathyroid surgery, and patients should be referred for parathyroidectomy only if they meet certain criteria. […] Many patients with primary hyperparathyroidism have a benign course and do not need surgery. […] The principal challenges in the management of hypercalcemia are distinguishing primary hyperparathyroidism from conditions that will not respond to parathyroidectomy and knowing when it is appropriate to refer the patient for surgery. […] It is essential that physicians know how to evaluate and optimally manage patients with hypercalcemia, because treatment and prognosis vary according to the underlying disorder.

• #87 Lithium induced hypercalcemia: an expert opinion and management algorithm | International Journal of Bipolar Disorders | Full Text

  https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-022-00283-3

  Abnormalities in plasma calcium and PTH levels homeostasis are frequently seen in patients treated with lithium, but a standardized and practical approach guiding clinicians on how to monitor and manage the abnormalities and their causes in the psychiatric setting are hitherto lacking. Here we present an evidence-based consensus driven management algorithm intended to provide a helpful tool for clinicians monitoring long-term lithium treatment. Besides assuring the detection and proper handling of relevant calcium abnormalities, the algorithm will likely diminish the potential risk of premature discontinuation of lithium treatment in patients who benefit from lithium, due to treatment emergent hypercalcemia. Finally, the algorithm may reduce the risk of clinicians avoiding the use of lithium in patients who would otherwise benefit due to uncertainties about management of this potential often treatable side effect.

• #88 Resistant Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK572109/

  Antiresorptive agents have proven to be effective in the management of resistant hypercalcemia. […] The mainstays of therapy include volume resuscitation, bisphosphonates, and calcitonin. However, despite preliminary treatment, denosumab has been proven to be an excellent choice of therapy in resistant hypercalcemia cases. […] The importance of the interprofessional approach cannot be under-emphasized. Early identification of symptomatic hypercalcemia by the emergency medicine physician is essential to initiate immediate hydration. […] Patients should be made aware of the mortality associated with severe hypercalcemia. Also, all available treatment options, including hemodialysis or parathyroidectomy, should be discussed, especially in cases of persistent/ resistant hypercalcemia.

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