Definition
"Clinical hypercalcemia" is a clinical condition in which the level of calcium in the blood exceeds normal concentration (compared to a reference population); for example, in the adult, it is possible to speak of hypercalcaemia when the plasma calcium exceeds the value of 10.5 mg / dl. The concentration of calcium in the blood is heavily influenced by the activity of calcitonin, parathormone and vitamin D.
Causes
Hypercalcemia is the result of excessive intestinal calcium absorption, decreased renal excretion or uncontrolled release of calcium from the bones.
- Risk factors: excessive intake of diuretics, vitamin D, vitamin A and thyroid hormones, high-protein diet, infections, inflammation, hyperparathyroidism, hyperthyroidism, sarcoidosis, tuberculosis, breast and lung cancer
Symptoms
Role of calcium in the body: maintenance of bone health, muscle contraction, release of hormones, maintenance of brain and nerve function
Since calcium is involved in numerous and important functions in the body, an abnormal and exaggerated concentration of plasma calcium can create a variable symptomatology: hypercalcaemia can induce apathy, mental confusion, muscle weakness, depression, dehydration, abdominal pain, bone pain, loss of appetite, gastric hyperacidity, frequent urination, nausea, constipation.
- Complications: severe arrhythmias, coma, renal failure
Information on Hypercalcemia - Hypercalcemia Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Ipercalcemia - Hypercalcemia Drugs.
drugs
Hypercalcemia is not a medical condition to underestimate: so much so that when the plasma concentration of calcium exceeds a certain value, hospitalization and emergency treatment are indispensable, even before the cause is clarified.
A hypertensive patient taking thiazide diuretics may be at risk of hypercalcaemia; analogous speech for which is submitted to an integration of vitamin D beyond the due: in these cases, it is necessary to reduce the calcium intake with the diet, but also to suspend vitamin D supplementation and replace a thiazide diuretic with another drug .
Acute hypercalcemia must be treated with an intravenous infusion of sodium chloride (0.9%), to correct dehydration; in cases of severity it is conceivable to administer drugs useful to inhibit bone mobilization, such as bisphosphonates and pamidronic acid: these drugs exert their therapeutic activity through the inhibition of bone resorption, consequently increasing the elimination of the mineral through urination. Calcitonin is one of the most widely used drugs in therapy to bring calcium to normal, altered by hypercalcemia (especially in the context of malignant diseases).
Again, corticosteroids can exert their therapeutic function excellently when hypercalcemia is associated with excessive vitamin D or sarcoidosis.
Among the alternative treatments, less used, we recall the chelating drugs (eg trisodium edetate): we are talking about an old generation therapy, currently less used than in the past for its showy side effects (renal damage) and for the local pain caused at the injection site.
In some severe cases, when hypercalcemia results from hyperparathyroidism, parathyroidectomy, as well as the removal of one or more parathyroid glands is conceivable.
Glucocorticoids : indicated to counteract the effects derived from the accumulation of vitamin D in the blood. The administration of these drugs is also indicated for patients suffering from hypercalcaemia in the context of sarcoidosis.
- Prednisolone ( eg. Deltacortene, Lodotra ): the indicative dose for the treatment of hypercalcaemia suggests taking 30-60 mg of the drug a day, divided into three daily doses.
Bisphosphonates : these drugs, to be taken intravenously, are indicated in the treatment of hypercalcaemia, to obviate the destruction of the bone that, inevitably, would increase the release of calcium in the blood. In other words, bisphosphonates inhibit bone resorption by osteoclasts. Together with the association furosemide + physiological solution, bisphosphonates are the first-line drugs used in the treatment of hypercalcaemia. Below, the most used in therapy.
- Pamidronate (eg. Pamidronate disodium mayne, Aredia): the indicative dose for the treatment of hypercalcaemia suggests to take 60-90 mg of drug, in single dose, for slow intravenous infusion of 2-24 hours. The long infusion duration (more than 2 hours) is widely used to minimize the risk of renal toxicity. In the case of severe hypercalcaemia, it is recommended to administer a second dose, following the treatment plan carried out for the first infusion: it should be emphasized, however, that at least 7 days must elapse between one dose and another.
- Zolendronate (eg. Zometa): available in powder and solvent, and concentrate to be diluted, the drug performs its therapeutic activity like the previous one. The dosage must be established by the doctor.
- Ibandronic acid (eg Bondronat, Bonviva, Ibandronic acid teva, Iasibon, Ibandronic acid sandoz): in the form of an injectable solution, the drug is widely used in therapy for the treatment of hypercalcaemia associated with malignancy. Administer the IV infusion drug of 2-4 mg, depending on the severity of hypercalcaemia. In general, the duration of therapy is 7 days.
- Sodium etidronate (eg etidron): more than for hypercalcaemia, the drug under examination is used to treat bone resorption in Paget's disease. In the case of hypercalcemia associated with cancer, its use has been severely limited due to the toxicity of the drug exerted on the kidney.
The intake of bisphosphonate drugs for the treatment of hypercalcaemia can induce: leucopenia, hypophosphataemia and hypocalcemia
Loop diuretic drugs : they promote the reduction of calcium levels in the blood, ensuring a correct functioning of the kidneys
- Furosemide (eg Lasix): often the administration of furosemide for the treatment of hypercalcaemia is associated with an infusion of physiological solution. In patients in whom renal function is normal - or in any case not heavily compromised - it is conceivable to control plasma calcium levels by increasing renal elimination through the expansion of extracellular volume. The infusion of lasix + physiological solution allows to obtain a urinary volume equal to 3 liters per day. It is recommended, in similar situations, to monitor the level of potassium in the blood to avoid hypopotassemia: to avoid this problem, it is recommended to inject a physiological solution containing KCl.
Calcitonin : it is a hormone produced by the thyroid, also to be taken to reduce bone absorption and progressive bone loss.
- Calcitonin (eg Calcitonin Sandoz, 50-100UI, injectable preparation): the drug reduces blood calcium by inhibiting osteoclast activity: in this way, the rate of calcium release from the bone is slowed. It is recommended to take a dose of subcutaneous / intramuscular medication of 4-8 IU / kg every 12 hours. It is advisable to combine prednisone with calcitonin therapy, to obtain greater benefit in a shorter time.
Chelating drugs : to be used with caution for the treatment of severe hypercalcaemia. The drug should be administered by injection: the drug can cause pain at the injection site, as well as kidney damage.
- Edetate disodium (edta): indicated both for acute calcium intoxication and for the treatment of severe hypercalcaemia. Consult your doctor. The drug is not used as a first line for the regularization of plasma calcium levels.
Other drugs used to restore plasma calcium concentration:
- Gallium nitrate (eg Ganite, not available in Italy): inhibitor of bone resorption, it is indicated for the treatment of hypercalcaemia associated with malignant diseases (bone metastasis, parathyroid carcinoma). Second choice drug for the treatment of hypercalcaemia, to be taken in case of failure of the therapy with loop diuretics and saline solution. Do not take in case of acute renal failure. The duration of therapy to bring the plasma calcium levels back to balance is approximately 2 weeks. In patients with mild hypercalcaemia, the recommended dosage is, indicatively, less than 100mg / m2 / day, for 5 consecutive days. The daily dose can be given by slow intravenous infusion (within 24 hours).
- Chloroquine phosphate (eg Chloroquine, Cloroc Fos FN): the active ingredient is indicated to reduce plasma calcium levels in patients suffering from hypercalcemia due to sarcoidosis. It is recommended to take a dose of 500 mg a day. The drug can cause damage to the retina.
- Mitramicin or plicamycin (eg Mithracin): the administration of this drug is reserved for patients suffering from humoral hypercalcemia from malignant metastasis: it is observed that, following the administration of the drug, the concentration of calcium in the blood is reduced in 12-36 hours, taking a dose of drug peri at 25 mcg (0.025 mg) / kg of body weight, for a period of 3-4 days. Consult your doctor.
When hypercalcemia does not benefit from therapy with the drugs described above, it is possible to subject the patient to dialysis or hemodialysis, useful for removing excess waste substances and calcium accumulated in the blood; in this way, it is possible to restore the correct calcemia value.
Cancer-induced hypercalcaemia passes secondly: the patient will undergo a chemotherapy / radiotherapy treatment or a surgical intervention aimed at treating the tumor; the removal of diseased cells will also favor the recovery from hypercalcaemia.
