Treatment of symptomatic hypercalcemia is treating the underlying cause but also some symptomatic management. Usually aggressive IV hydration is warranted sometimes even at 150-200-250 CC/HR.
Once volume depletion is addressed, a loop diuretic MAY be used for augmentation of calcium excretion.
A recent review and analysis published in Annals of Internal Medicine sheds some light about use of loop diuretic in this setting.
The review suggests the following points:
1. Aggressive hydration is necessary
2. Use of diuretics without aggressive hydration might be harmful
3. Found only 9 articles documenting the use of furosemide in hypercalcemia and latest one published in 1983 and total was only 37 patients.
4. Average dose was 1120mg over 24 hours ( really??)
5. Normalization of Ca occurred in only 14 of 39 cases
6. Study with lower doses didn't achieve normalization ( and what do we use????)
7. complications of other electrolyte disorders ensued
8. Finally, recommended against the use of this agent routinely except for cases of volume overloaded with hypercalcemia.
I think the tile of the paper listed below nicely puts it:- Furosemide in hypercalcemia is an unproven but common practice ( really not evidence based)
- ► 2018 (55)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- Concept Map: Focal Segmental Glomerulosclerosis(FS...
- 2009: The first few Nephronpower posts
- Novartis announces termination of ALTITUDE study
- eAJKD: Take ESRD family history Poll
- eAJKD: IgA Nephropathy Word Search
- TOPIC DISCUSSION: What about BUN - and when its to...
- Renal Fellow Network: Top nephrology-related stori...
- Journal Club: FGF-23 and LVH
- eAJKD: Test your knowledge on Glomerular Diseases ...
- eAJKD: Peritoneal Dialysis Strikes Back
- TRANSPLANT ROUNDS: Test your knowledge of inducti...
- CONSULT ROUNDS: AA vs AL Amyloidosis
- CONSULT ROUNDS: Calciphylaxis Treatment Options
- eAJKD: Home Hemodialysis
- eAJKD: IgA Nephropathy and Vitamin D therapy
- CLINICAL CASE 48: Answers and Summary
- TOPIC DISCUSSION: Lithium and timing of dialysis?
- IN THE NEWS: Transplantation and hypotension
- TOPIC DISCUSSION: FUROSEMIDE in HYPERCALCEMIA
- eAJKD: PTLD quiz!
- Azathioprine vs MMF: Transplantation for the socie...
- eAJKD: family history of ESRD- what does that mean...
- The Call of Renin!
- QUIZ:What causes Green urine? Answers
- CONSULT ROUNDS: Renal Infarcts
- ▼ December (25)
- ► 2010 (461)