Hypercalcemia and electrolyte disturbances in malignancy

Electrolyte disorders related emergencies in children

This article provides a comprehensive overview of electrolyte and water homeostasis in pediatric patients, focusing on some of the common serum electrolyte abnormalities encountered in clinical practice. Understanding pathophysiology, taking a detailed history, performing comprehensive physical examinations, and ordering basic laboratory investigations are essential for the timely proper management of these conditions. We will discuss the pathophysiology, clinical manifestations, diagnostic approaches, and treatment strategies for each electrolyte disorder. This article aims to enhance the clinical approach to pediatric patients with electrolyte imbalance-related emergencies, ultimately improving patient outcomes.Trial registration This manuscript does not include a clinical trial; instead, it provides an updated review of literature.

Electrolyte disturbances and acute kidney injury in patients with cancer

The interrelation between kidney disease and cancer is complex and reciprocal. Among the most frequent cancer-associated kidney diseases are the electrolyte and acid-base disturbances, which occur frequently and often are associated with an ominous prognosis, and acute kidney injury. Tumor lysis syndrome is a potentially life-threatening condition that frequently occurs in patients with a high tumor burden and high cellular turnover after cytotoxic therapy (including steroids in steroid-sensitive hematologic malignancies). Electrolyte and acid-base disturbances are the consequence of neoplastic spread, anticancer treatment, or, more rarely, paraneoplastic phenomena of all types of tumors. This article reviews hyponatremia and hypernatremia, hypokalemia and hyperkalemia, hypomagnesemia, hypercalcemia and hypocalcemia, hypophosphatemia, and the most important disturbances in acid-base balance in cancer patients. Acute kidney injury (AKI) is a frequent occurrence in cancer patients and has the potential to substantially alter the outcome of patients with cancer and jeopardize their chances of receiving optimal cancer treatment and a potential cure. As in many other circumstances, the etiology of AKI in cancer patients is multifactorial. Initiation and/or continuation of dialysis in the AKI cancer patient should be based on the general clinical condition and overall life expectancy and the personal patient expectations on quality of life after eventual recovery.

Electrolyte complications of malignancy

A thorough working knowledge of the diagnosis and treatment of life-threatening electrolyte abnormalities in cancer patients, especially hyponatremia, hypoglycemia, and hypercalcemia, is essential to the successful practice of emergency medicine. Although most minor abnormalities have no specific treatment, severe clinical manifestations of several notable electrolytes occur with significant frequency in the setting of malignancy. The treatment of life-threatening electrolyte abnormalities is reviewed here. Promising future treatments directed at the underlying physiology are also introduced.

The causes of hypercalcemia in Okinawan patients: an international comparison

OBJECTIVE

Our objective was to determine the causes and relative prevalence of hypercalcemia in patients at a major community hospital in Okinawa, Japan. Additionally, we compared these causes of hypercalcemia with the previously published international data.

MATERIALS AND METHODS

We analyzed all patients with hypercalcemia in a community teaching hospital in Okinawa, Japan, from 1999 to 2002 and determined the cause of hypercalcemia in each patient. We also performed a literature review of the original articles describing causes of hypercalcemia in patients from Eastern as well as Western countries.

RESULTS

We identified 145 patients with hypercalcemia (median age, 69; range, 22 to 97). Major causes included malignant disorders (n=100; 69%), primary hyperparathyroidism (n=31; 21%), vitamin D-induced (n=4; 3%), and miscellaneous or unknown cause in 11 (8%). Among malignant disorders, adult T cell leukemia was the most frequent (n=35), being followed by lung cancer (n=25). Breast carcinoma was less prevalent (n=4).

CONCLUSION

The major causes of hypercalcemia are malignancy and primary hyperparathyroidism in Okinawan Japanese patients. Adult T cell leukemia and lung carcinoma are among the top leading malignancies, while breast carcinoma is less frequent in this patient population. The etiologic prevalence of hypercalcemia in the Eastern population including Okinawans is significantly different from that in the Western population.

Disodium pamidronate for treating severe hypercalcemia in a hemodialysis patient

BACKGROUND

A 48-year-old man with a recent diagnosis of multiple myeloma and rapidly progressive oliguric end-stage renal disease requiring hemodialysis, presented with a serum calcium concentration of 3.4 mmol/l (13.6 mg/dl).

INVESTIGATIONS

Serum laboratory analysis, electroencephalogram, MRI of the brain and bone marrow, and kidney biopsies.

DIAGNOSIS

Hypercalcemia secondary to multiple myeloma.

MANAGEMENT

Short-term intravenous disodium pamidronate therapy (30 mg daily) and daily monitoring of serum calcium concentration.

Hypercalcemia in Langerhans cell histiocytosis: is it therapy-related?

Hypercalcemia is not known to be a common occurrence in patients with Langerhans cell histiocytosis (LCH). This manuscript describes an infant with multisystem LCH who developed an elevated serum calcium level while on therapy. Unlike other cases of hypercalcemia, this patient did not have evidence of bone involvement. Based on the apparent rarity of the condition and the clinical presentation, it is likely that hypercalcemia in LCH is a multifactorial process. The author presents evidence supporting the hypothesis that the treatment regimen is a major factor in the etiology of this metabolic abnormality and suggests that calcium levels be routinely measured during therapy.

Severe hypophosphatemia during hematopoietic reconstitution after allogeneic peripheral blood stem cell transplantation

A patient suffering from acute myeloid leukemia (FAB M5a) received a PBSC allograft from a matched, related donor. On day 13 after transplantation severe hypophosphatemia (0.21 mmol/l) was first noted which persisted irrespective of intravenous phosphate administration, and within 2 days reached concentrations below 0.13 mmol/l. After repeated phosphate substitution serum phosphate returned to 1.40 mmol/l on day 17. Phosphate in urine, and calcium in serum were recorded as unchanged throughout. Clinical signs and symptoms due to severe hypophosphatemia were not observed except for paresthesia in the lower extremities. The precipitous fall in serum phosphate coincided with hematopoietic reconstitution as reflected by a steep rise in leukocyte count from 0.08 x 109/l on day 10 to 5. 94 x 109/l on day 15 after transplantation. Thus, isolated hypophosphatemia was likely the result of excessive cellular phosphate uptake during hematopoietic reconstitution. Electrolyte monitoring after PBSCT should include serum phosphate to identify the hypophosphatemia associated with hematopoietic recovery.

Hypercalcemia complicating leukemic transformation of agnogenic myeloid metaplasia-myelofibrosis

Hypercalcemia is a common and potentially life-threatening metabolic derangement associated with many malignancies, especially solid tumors and multiple myeloma. Hypercalcemia has been reported only rarely with acute myelogenous leukemia. We describe a patient who developed hypercalcemia in association with transformation of agnogenic myeloid metaplasia into M7 acute myelogenous leukemia. Laboratory investigation revealed low levels of serum parathyroid hormone, undetectable levels of parathyroid hormone-related peptide, and normal levels of 25-hydroxyvitamin D. These observations suggest that another mediator was responsible for hypercalcemia in this patient. Awareness of this rare complication of acute myelogenous leukemia is essential for prompt diagnosis and management.

Hypercalcemia

OBJECTIVES

To provide a review of hypercalcemia of malignancy, including the incidence, pathophysiology, signs and symptoms, treatment, and nursing interventions.

DATA SOURCES

Research studies, review articles, proceedings from nursing conferences, and book chapters.

CONCLUSIONS

Hypercalcemia of malignancy is difficult to diagnose because the signs and symptoms are similar to those experienced by patients with end-stage cancers. Knowing the cancers and histologic cell types that are at high risk for hypercalcemia assists in early diagnosis and treatment. Treatment decisions must consider potential benefits and their risks and affect on quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Hypercalcemia of malignancy as a metabolic oncologic emergency requires accurate assessment and rapid intervention. Early recognition by the patient, family, and health care professionals can result in improved quality of life.

Paraneoplastic syndromes in metastatic disease

OBJECTIVES

To provide an overview of selected paraneoplastic syndromes associated with metastatic disease with potential life-threatening implications, and the nursing implications of each.

DATA SOURCES

Published articles and book chapters related to paraneoplastic syndromes in metastatic disease.

CONCLUSIONS

Paraneoplastic syndromes in metastatic disease are associated with various primary tumors and can affect many organ systems. Early recognition and management can minimize the potential life-threatening effects of the syndromes.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses need to be aware of the potential for paraneoplastic syndromes that can compromise a patient's health status. Appropriate assessment and intervention of paraneoplastic syndromes can have a positive impact on patient outcomes and quality of life.