In the case of the 57-year-old man who is unresponsive, an intravenous line is established and a normal saline solution is infused. Because of his fatigue and constipation in the face of known lung cancer, a diagnosis of hypercalcemia is suspected, and serum electrolytes are drawn. His serum calcium level is measured at 15.2 mg/dL (3.8 mmol/L), and isotonic saline is started at 250 mL/hour. He is treated with intravenous furosemide and, after consultation with the oncologist on call, he is given 4 mg of zoledronic acid intravenously, as well as salmon calcitonin, 4 IU/kg intramuscularly every 12 hours. He becomes alert, and his serum calcium declines to 11.5 mg/dL 36 hours later. He is at baseline mental status 18 hours after admission.
Cancer remains the second leading cause of death in the United States. With an aging population, it is inevitable that the number of patients with acute illness and disability from malignancy will increase. The accurate diagnosis and treatment of metabolic emergencies in cancer patients can potentially forestall disability and enhance quality of life.
The management of tumor lysis syndrome centers on establishment of hydration and control of elevated uric acid and serum potassium.
The mainstays of emergency management of hypercalcemia from malignancy are hydration and the use of furosemide and bisphosphonates.
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Contributors and Disclosures
Contributors: Dr. Jonathan M. Glauser wrote “Metabolic and Infectious Emergencies in Cancer Patients.” Dr. Glauser is vice chair of the Department of Emergency Medicine at the Cleveland Clinic Foundation and faculty member in the MetroHealth Case Western Reserve Emergency Medicine Residency Program in Cleveland, Ohio.