Oncological Emergencies: Hypercalcaemia
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Transcript of Oncological Emergencies: Hypercalcaemia
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HypercalcaemiaOncological Emergencies
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What is
Hypercalcaemia?
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Elevated serum calcium level
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Normal range: 2.12 – 2.65 mmol/l
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CalciumCa
20
40
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Most abundant
Electrolyte
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Provides hardness and
strength to bone matrix
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Initiates muscle
contractions
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Maintains normal cellular
permeability
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Part of clotting cascade
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Causes of
Hypercalcaemia?
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Cancer is the 2nd most common cause of Hypercalcaemia after Primary Hyperparathyroidism.
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Most common Non-malignant associated Hypercalcaemia
• Hyperparathyroidism• Excess Vit D• Sarcoidosis• Familial metabolic disorders
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Most Common malignancy associated hypercalcaemia
• Non small cell lung cancer (sq cell)• Breast cancer• Renal cell cancer• Multiple Myeloma, and lymphoma (up
to 40%)• Head and neck cancers• Cancer metastasising to bone (lung,
breast, kidney,)• Some cancers with bone mets do not
cause hypercalcaemia eg prostate
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Symptoms of
Hypercalcaemia?
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Only 20%of patients exhibit symptoms
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“Stones, bones, abdominal
groans, and psychic
overtones”
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Manifestations of Hypercalcaemia
• Bone pain• Renal stones• Abdominal pain and constipation• Confusion / depression• Vomiting• Thirst• Excessive Urination• Loss of appetite and weight• Weakness• Fatigue• Renal Failure• Pancreatitis• Shortening of QT interval• Non specific symptoms “they’re just not right….”
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Diagnosis
• Bloods– Elevated serum calcium– Renal Impairment
• ECG– Arrhythmias as calcium is important in cardiac
conduction• X-ray
– Shows specific area of bony pain• Bone scan
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Treatment of
Hypercalcaemia?
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All patients with hypercalcaemia
should be actively treated
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Rehydration
Normal Saline
1 litre over 24 hours with adequate K+ and a mild loop diuretic (furosemide).
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Bisphosphonates
Pamidronate is used unless pamidronaterefractory in which case zoledronic acid
Based on urea / calcium level after 24 hours of rehydration
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Calcitonin
Only if calcium is extremely raised or patient has significant ECG changes
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Nursing implications of
Hypercalcaemia?
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Strict Fluid Balance.
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Monitor confusion levels.
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Observe for non-specific
symptoms.
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Conclusion
• Easily treated condition
• Often not picked up on routine bloods
• Need to remember to check calcium if patient had known malignant disease and isn’t themselves
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