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June 1972

Treatment of Hypercalcemia: Comparison of Intravenously Administered Phosphate, Sulfate, and Hydrocortisone

Author Affiliations

New York

From the Division of Medical Research, Sloan-Kettering Institute for Cancer Research; and the departments of medicine, Memorial Hospital for Cancer and Allied Diseases, and Cornell University Medical College, New York. Dr. Fulmer is now with Princeton Medical Group, Princeton, NJ.

Arch Intern Med. 1972;129(6):923-930. doi:10.1001/archinte.1972.00320060071008

Comparative effectiveness of six to eight hour infusions of phosphate, sulfate, and hydrocortisone was studied in 22 hypercalcemic patients with neoplastic disease. Mean maximum reduction in serum calcium level with phosphate was dose dependent: 25 millimols, 1.1 mg/100 ml; 50 millimols, 2.44 mg/100 ml; 75 millimols, 4.13 mg/ 100 ml; and 100 millimols, 6.08 mg/100 ml. The reduction was also directly related to the rise in serum phosphate level. Sulfate infusion (38.9 gm) caused an average maximum decrease of serum calcium of 1.87 mg/100 ml. Hydrocortisone (200 mg) produced minor inconsistent changes in serum calcium and phosphate levels. Infusions of phosphate caused reduction in urinary calcium and rise in phosphate level. Both sulfate and hydrocortisone infusions resulted in rises in urinary calcium and urinary phosphate. These studies demonstrate the superiority of phosphate in treatment of hypercalcemia and suggest guidelines for dose selection.

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