Recently, a lung squamous cell carcinoma patient was hospitalized because lung infection . During the hospitalization period, the patient first became unable to concentrate, and gradually became confused on the same day. Considering the recurrence of lung cancer in the patient, will there be brain metastasis? An emergency head CT was performed, and no abnormalities were found. The patient was diagnosed with blood tests and the electrolytes were urgently drawn, and the problem was discovered. It turned out that the patient's blood calcium was as high as 3.7 mmol/l. Hypercalcemia is a tumor metabolism emergency and is not dealt with in time and may be life-threatening. Clinically, the problem of hypercalcemia is sometimes ignored.
The most common type of disease that causes hypercalcemia is malignant tumors. It has been reported abroad that about 15-20% of tumor patients will develop hypercalcemia. In fact, nearly one-third of cancer patients experience hypercalcemia at some point in their disease process. The incidence rate is the highest among multiple myeloma and breast cancer , reaching 40%, followed by non-small cell lung cancer . Hypercalcemia can affect the function of multiple organs throughout the body and is more likely to endanger life than cancer itself, so once diagnosed, it should be treated urgently.
Some people think that lung cancer bone metastasis causes hypercalcemia. After the bone is destroyed by cancer cells, calcium is released into the blood. In fact, the most common cause of malignant tumor hypercalcemia is that tumor cells cause the secretion of parathyroid hormone (PTH)-related proteins. The function of parathyroid hormone-related proteins is similar to that of PTH, resulting in reduced bone absorption and renal calcium excretion. Hypercalcemia occurs when the calcium level at mobilization in the bones exceeds the threshold for renal excretion. Hypercalcemia is likely to occur regardless of bone destruction. In patients with bone metastasis and , the probability of hypercalcemia is higher.
What we hear most about blood calcium is that patients often ask us, doctor, sometimes my feet will cramp, is it because I have calcium deficiency, and whether I need to supplement calcium. Few people think of the harm of excessive blood calcium. In fact, hypercalcification is much more harmful than low calcium and is very urgent.
The harm of hypercalcemia is reflected in the following aspects:
1. Effect on neuromuscular Hypercalcemia can reduce neuromuscular excitability, manifested as fatigue, indifference, cognitive impairment of , and tendon reflex . Severe patients may experience mental disorders, wood stiffness and coma.
2. Effect on the heart Myocardial excitability and conductivity are reduced, and arrhythmia and atrioventricular block will occur.
3. Gastrointestinal symptoms: such as thirst, loss of appetite, nausea, vomiting, abdominal pain, diarrhea or constipation.
4. Damage to kidney The kidney is very sensitive to hypercalcemia and mainly damages renal tubular , which is manifested as renal tubular edema, necrosis, and basement membrane calcification. In the late stage, renal tubular fibrosis, renal calcification, and renal stones can be seen. The patient showed polyuria and even renal failure.
When serum calcium is greater than 4.5mmol/L, hypercalcemia may occur, severe dehydration, high fever, heart rhythm disorder, unclear consciousness, etc. The patient is prone to death from cardiac arrest , necrotizing pancreatitis and renal failure.
How to deal with hypercalcemia?
1. Intravenous fluid is the initial treatment for hypercalcemia, and rehydration is also diuretic. Recent studies have shown that loop diuretics are effective or have no evidence for the use of hypercalcemia patients. In addition, it is important to note that some drugs (such as thiazide diuretics) can increase calcium reabsorption.
2. The second is intravenous bisphosphate, which is the most commonly used drug for treating hypercalcemia. When necessary, you need to use glucocorticoid and calcitonin . For patients with hypercalcemia who are ineffective in zoledronate treatment or patients who are contraindicated for bisphosphonates due to severe renal damage, denozumab can be selected.
3. For patients who cannot tolerate large amounts of intravenous infusions (such as congestive heart failure, renal failure), dialysis may be required.
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