Treatment of Severe Hypercalcemia

00:01 Severe hyp-hypercalcemia, what do you want to do? Remember, with the severe hypercalcemia, there’s quite a bit of calcium that’s being filtered into the urine.

00:09 Thus may result in osmotic diuresis and kind of like what we talked about earlier with uncontrolled diabetes haemolytis.

00:15 What’s one of the first steps that you’re doing? Replenish, replenish, replenish the fluid.

00:21 Mobilization, if possible.

00:24 Remember, that mobilization, lightweight to a certain extent, may then also help with severe hypercalcemia.

00:34 Bisphosphonates allows for proper mineralization of the bone to remove the calcium out of the circulation, inhibit resorption.

00:43 Effect begins within two days, maximum at a week for bisphosphonates.

00:48 Calcitonin, technically, at this point, it may inhibit bone resorption.

00:55 That’s all that I wish to say about this, but in pathology, please make sure that you keep in mind with calcitonin, parafollicular C cells and use as a marker with medullary cancer of the thyroid.

01:07 Denosumab binds to RANK-ligand, thereby inhibiting the formation of Osteoclasts.

01:12 This, in turn, inhibits bone resorption and reduces the amount of calcium that gets released from the bone.

01:18 Glucocorticoids, effective in Vitamin D-mediated hypercalcemia.

01:24 So, for example, your patient, African-American lady, young, maybe in her early 40’s and she has hypertension and upon chest X-ray, you find these granulomas.

01:34 In addition to that, you find hypercalcemia and glucocorticoids seem to be quite effective in those patients who has sarcoidosis.

01:41 It inhibits the conversion or inhibits calcitriol production in general.