Hypercalcemia glucocorticoids

Vitamin D withdrawal is an obvious treatment for D toxicity (219). However, because of the 5—7 d half-life of plasma vitamin D and 20—30 d half-life of 25-hydroxy vitamin D, it may not be immediately successful. A prompt reduction in dietary calcium is also indicated to reduce hypercalcemia. Sodium phytate can aid in reducing intestinal calcium transport. Calcitonin glucagon and glucocorticoid therapy have also been reported to reduce semm calcium resulting from D intoxication (210). 

Corticotropin is used for diagnostic testing of adrenocortical function. This drug may also be used for the management of acute exacerbations of multiple sclerosis, nonsuppurative thyroiditis, and hypercalcemia associated with cancer. It is also used as an anti-inflammatory and immunosuppressant drug when conventional glucocorticoid therapy lias not been effective (see Display 50-1). 

Hypercalcemia can be treated by (1) administering 0.9% NaCl solution plus furosemide (if necessary) renal excretion (2) the osteoclast inhibitors calcitonin, plicamycin, or clodro-nate (a bisphosphonate) bone calcium mobilization i (3) the Ca +chelators EDTA sodium or sodium citrate as well as (4) glucocorticoids. 

Calcitonin—Paget s disease and hypercalcemia Estrogens Glucocorticoids Biphosphonates—postmenopausal osteoporosis Eluoride... 

Glucocorticoid antagonism Idiopathic hypercalcemia Malabsorption syndrome Sarcoidosis Steatorrhea Tropical sprue... 

A 31-year-old pregnant woman (35 weeks gestation) developed hypercalcemia and interstitial nephritis possibly associated with omeprazole 20 mg/day for over 8 weeks (20). Investigations excluded other causes of hypercalcemia. She recovered after drug withdrawal and treatment with glucocorticoids. 

Glucocorticoids Osteoporosis occurs in Cushing s disease and in patients treated with glucocorticoids for immunosuppression. Glucocorticoids are used in the treatment of hypercalcemia. Decrease intestinal Ca + absorption may antagonize 1,25-(0H)2D or PTH may directly stimulate parathyroids may have direct effects on intestine and bone independent of PTH and 1,25-(0H)2D. 

Glucocorticoids are usually effective in the treatment of hypercalcemia resulting from multiple myeloma, leukemia, lymphoma, sarcoidosis, and hypervitaminoses A and The mechanisms of... 

Example compounds causing hypercalcemia include thiazides, hthium, calciferol-containing rodenticides, estrogens, and glucocorticoids... 

E. Glucocorticoids The glucocorticoids have several effects already referred to (eg, protein catabolism see Chapter 39) that inhibit bone mineral maintenance. As a result, chronic systemic use of these drugs is a common cause of osteoporosis in adults. However, these hormones are useful in the intermediate-term treatment of hypercalcemia. 

Calcitonin is often used in Paget s disease to control hypercalcemia. The answer is (D). Long-term therapy with glucocorticoids such as prednisone is associated with a reduction in bone mineral density and an increased risk of fractures. The other drugs are not known to have significant effects upon bone or serum calcium. The answer is (C). 

Glucocorticoids Regulate carbohydrate, lipid and protein metabolism block inflammation regulate body s immune response Indications Asthma, advance pulmonary tuberculosis, pericarditis, acute and chronic inflammation, adrenal insufficiency, antenatal use in preterm labor, hypercalcemia, cerebral edema, acute SCI, MS, shock Common drug examples ... 

Systematic reviews In a narrative review of teriparatide in the treatment of glucocorticoid-induced osteoporosis there were higher frequencies of nausea (RR=2.3), abdominal cramps (RR=3.2), and hypercalcemia (RR=9.7) [62 ]. 

A 31-year-old HIV-positive woman developed progressive renal insufficiency while taking tenofovir and emtridtabine in combination with efavirenz she was also taking oral glucocorticoids, low-dose colecalciferol 25 micrograms/day, and calcium 500 mg/day, which resulted in hypercalcemia and contributed to the renal impairment [126 ]. 

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