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Some cancer patients experience hypercalcemia, which causes damage to many organs, in which damage to the heart increases the risk of death for the patient. This is a condition that requires early detection and emergency treatment.
1. Hypercalcemia in cancer
Hypercalcemia after cancer is a fairly common medical emergency, occurring in 20-30% of cancer patients.
Hypercalcemia can be caused by some tumors affecting the bone or metastases that can destroy bone, some tumors producing a protein that closely resembles parathyroid hormone. Some types of cancer can cause hypercalcemia such as lung cancer, multiple myeloma, blood cancer, kidney cancer, gastrointestinal cancer, lymphoma, breast cancer...
Increased calcium in Cancer is a dangerous condition that increases the risk of death for the patient. This condition needs to be diagnosed and treated early.
Tăng canxi máu ở bệnh nhân ung thư là tình trạng nguy hiểm, tăng nguy cơ tử vong
2. Diagnosis of hypercalcemia
Diagnosis is based on clinical symptoms and laboratory tests.
Clinical signs
Neurological: Muscle aches, cramps, muscle spasticity, proximal paralysis, fatigue, depression, headache, somnolence and possibly coma. Gastrointestinal: Anorexia, nausea, vomiting, constipation, abdominal pain may be severe. Cardiovascular: Causing arrhythmia, increased blood pressure. Kidney: Pre-renal failure due to dehydration or also renal failure in the kidney because kidney damage due to calcium deposition in the kidney causes oliguria, anuria. However, the clinical manifestations of mild hypercalcemia are often nonspecific and should be based on laboratory tests.
Subclinical
Quantification of blood calcium : Blood calcium > 2.6 mmol/l or ionized calcium > 1.3 mmol/l Electrocardiogram to assess heart damage: PR segment is prolonged, QT is short, signs can be seen Cardiac arrhythmias such as atrial fibrillation, ventricular fibrillation. Other tests needed to help predict the disease: Protein, blood albumin decreased, urea, blood creatinine increased.
Chẩn đoán cận lâm sàng tăng canxi máu qua định lượng máu, điện tim, xét nghiệm
3. Treatment of hypercalcemia in cancer
After diagnosing hypercalcemia in cancer, it is necessary to classify to determine the extent of the disease. Depending on the severity of the disease, there are appropriate treatment measures.
Cases of mild and moderate hypercalcemia do not need treatment, but only need to rest, limit exercise, reduce calcium-rich foods, combine with intravenous fluids and use diuretics to remove excess calcium. excess in the urine.
When there is hypercalcemia >3mmol/l, it is necessary to conduct emergency treatment to lower blood calcium by the following methods:
Increase calcium excretion by measures:
Volume compensation: Isotonic fluid replacement sodium chloride 0.9% or 5% glucose with potassium chloride 0.5g at the rate of 200-300ml/hour, attention should be paid to infusion in patients with heart failure, renal failure to avoid causing acute pulmonary edema. Combined with magnesium sulphate 1g per liter of 0.9% sodium chloride solution, intravenous infusion. Diuretics (furosemide 40-80 mg IV every 2 to 4 hours) after volume replacement and hemodynamic stability. Monitor salt and electrolyte loss caused by diuretics. In case of severe hypercalcemia that does not respond to the above treatments or the patient has renal failure, pulmonary edema, peritoneal dialysis or hemodialysis should be performed. Reduce calcium absorption by:
Do not put a lot of calcium into the muscle. can be through the digestive tract such as eating a lot of fish, bones, milk and dairy products.... Use corticosteroids if there is an excess of vitamin D in the blood. Enhance calcium attachment to bone:
Calcitonin: Dose of 250-400 units (or a dose of 4-8 units/kg) mixed with 0.9% NaCl isotonic saline solution, infused intravenously for 6-8 hours, Monitor blood calcium levels, if serum calcium levels decrease, can repeat calcitonin 4-8 units/kg every 6-12 hours, or subcutaneously or intramuscularly 4 units/kg every 12 hours . Bisphosphonate combination: Pamidronate 60-90mg (or 1-1.5mg/kg) mixed in 0.9% NaCl or 5% glucose intravenously, slow infusion rate, not more than 60mg/hour. Prednisolone at doses ranging from 20 to 40 mg/day may be effective if hypercalcemia is caused by lymphoma or multiple myeloma. With steroid therapy can help reduce the use of bone resorption. However, some cases increase the risk of osteoporosis in patients. Treatment of the cause: Combination of radiation therapy, systemic chemotherapy is also indicated to help reduce blood calcium.
4. How to prevent hypercalcemia in cancer
A number of measures are also applied to limit hypercalcemia, including:
Drink plenty of water to avoid reducing circulating volume, helping to eliminate excess calcium from the body through urine. Control vomiting. Excessive vomiting causes dehydration, which reduces the amount of urine, thereby limiting the amount of calcium that is excreted through the urine. Increase activity to avoid lying down a lot to limit bone destruction, helping to increase calcium attachment to bones. Avoid using drugs indiscriminately, because these drugs can be the risk of hypercalcemia. When there are signs of increased calcium status, it is necessary to notify the doctor immediately. Hypercalcemia in cancer is a fairly common condition, treatment should be carried out quickly to limit dangerous complications, especially cardiovascular complications.
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Reference source: medinet.gov.vn
