Drugs for the treatment of hypercalcaemia

Salmon calcitonin in the acute treatment of moderate and severe hypercalcemia in man

The effect of i.v. infusions with salmon calcitonin was evaluated in the treatment of acute hypercalcemia in 12 patients. Clinical improvement and a less critical level of serum calcium were achieved within 24 hours for eight of the patients, for another two after treatment for 48 hours. In malignant conditions (six patients) calcitonin was less effective, which could be evaluated within 24 hours. In addition to rehydration, the rapid onset of action and the lack of side-effects make calcitonin a drug of first choice in the treatment of acute hypercalcemia.

Immobilization hypercalcaemia due to low bone formation and responding to intravenous sodium sulphate

A young man developed acute renal failure and hypercalcaemia following severe burns. The hypercalcaemia was initially controlled by haemodialysis, but it persisted after return of renal function. Plasma PTH was inappropriately elevated, but the nephrogenous cyclic adenosine monophosphate level was low; thus the PTH was probably not biologically active, and may have been artefactually elevated by the moderate renal impairment. Bone histology, showed a normal resorbing surface, but a zero forming surface, implying that the bone dissolution leading to hypercalcaemia resulted from a failure of bone formation. Because of widespread infection and impaired renal function, the hypercalcaemia could not be treated by corticosteroid drugs, mithramycin or phosphate, and there was no response to salmon calcitonin. He was therefore treated with intravenous sodium sulphate, which increased urinary calcium excretion and reduced the plasma calcium. Sodium sulphate still has a role in the treatment of patients with hypercalcaemia.

Hypercalcaemic stupor as a presentation of lymphosarcoma

A case is reported of a 32 year old woman with a two year history suggestive of schizophrenia who presented in stupor. This proved to be due to hypercalcaemia with a concomitant high cerebrospinal fluid calcium concentration associated with previously unsuspected lymphosarcoma. Necropsy revealed no significant intracranial abnormality, and mechanisms that may have been involved in the production of the impaired consciousness are discussed.