Malignant hypercalcemia is the leading cause of hypercalcemia in hospital practice and is the most common life-threatening metabolic disorder associated with cancer.1,2 Left unattended, clinical deterioration is often rapid, resulting in profound volume depletion, azotemia, neuromuscular irritability, and progressive obtundation. When it is properly managed, however, responses may be gratifying, with symptomatic improvement achieved within days of initiation of treatment. The ideal treatment of patients with cancer-related hypercalcemia is cytoreductive therapy directed against the underlying malignancy. For the vast majority of patients, however, this is an unrealistic option, since most have advanced disease and have failed primary cytotoxic therapy. In the acute setting, measures to restore plasma volume and enhance calciuresis with vigorous intravenous hydration remain the cornerstone of therapy. Although this treatment is effective in the short term, fewer than 30% of patients can be expected to achieve normocalcemia with hydration alone,3,4 and most will require additional
List A. Malignant HypercalcemiaThe Choice of Therapy. Arch Intern Med. 1991;151(3):437–438. doi:10.1001/archinte.1991.00400030007001
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