Hypercalcemia may be observed in approximately 15-30% of newly diagnosed patients with MM.11,12 The mechanism of hypercalcemia is likely due to increased osteoclastic resorptive activity.13 Calcium levels should be corrected for serum albumin. Furthermore, some patients may have spurious elevations of serum calcium because of increased binding by paraproteins. Therefore, ionized serum calcium levels should be measured to aid in the diagnosis of hypercalcemia for patients with high monoclonal protein levels.3

Clinically, hypercalcemia is associated with lethargy, confusion, polydypsia, polyuria, constipation, and nausea.11 Untreated hypercalcemia will lead to renal insufficiency, a problem to which patients with MM are already prone. Therefore, prompt treatment once recognized is essential.

Urgent treatment of hypercalcemia is accomplished through increased urinary calcium excretion by volume expansion with intravenous saline. The addition of diuretics to aid in maintaining adequate urine output and calciuresis may cause other electrolyte abnormalities and exacerbate volume depletion. Therefore, diuretics are probably best avoided in the initial management of hypercalcemia. Some investigators recommend corticosteroids, i.e., prednisone 25 mg daily as an adjunctive treatment.12

Bisphosphonates inhibit the resorptive action of osteoclasts (see the next section on skeletal complications) and can be effective in the management of hypercalcemia in the patient with MM.1415 Two bisphosphonates, pamidronate (Aredia; Novartis Pharmaceuticals, East Hanover, NJ) and zoledronate (Zometa; Novartis Pharmaceuticals, East Hanover, NJ) have been studied for the treatment of hypercalcemia of malignancy.16 One large randomized trial suggested that zoledronate (4 mg or 8 mg) may be superior to pamidronate (90 mg) in achieving corrected serum calcium levels to less than 10.8 mg/dL, time to response, and duration of response.16 However, this study, which included 275 eligible patients with hypercalcemia of malignancy, enrolled only 23 (8.4%) with MM.16 Therefore, it is reasonable to treat MM patients with hypercalcemia with either agent.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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