Hypercalcemia isn't a particularly common cause of critical illness, but when encountered this requires immediate treatment. Fortunately, advances in the management of hypercalemia have clarified how to control this safely and definitively. Forced diuresis with furosemide has largely fallen by the wayside, simplifying fluid and electrolyte management. The cornerstone of therapy is generally simultaneous initiation of calcitonin and an IV bisphosphonate.
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Excellent as always. I’m curious why albumin is not part of the fluid resuscitation strategy for hypercalcemia. Is it that the binding of calcium while in the short term might be helpful that it doesn’t help with decreasing total body levels over time?
You list Pamidronate as contraindicated with gfr < 30. the Journal of Clinical Oncology guidleines for bone modifying agents in MM suggest you can give Pamidronate 90 mg IV over 4-6 hrs. jco.2017.76.6402.pdf . you can provide a rational to the discrepancy in your recommendation vs theirs. thanks.