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发布于:2020-11-27 13:04:23  访问:3 次 回复:0 篇
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Carbonic Anhydrase Inhibitor
Although we did not limit the search by underlying cause, we identied only case reports and uncontrolled case series for nonmalignant causes.Hydration with normal saline and immediate institution of bisphosphonate therapy is the treatment of choice.No consistently rapid effect was reported; durations of therapy ranged from hours to days.The only report in which investigators administered lower doses. Monitoring was intense and frequently invasive, involving aggressive replacement of hourly urine output with calculation and replacement of urinary electrolyte losses every to hours.One patient went into a coma from severe hypernatremia, hypophosphatemia, and metabolic acidosis and tetanic crisis. Current texts typically recommend doses ranging from to mg and make no recommendations on monitoring.We identied no studies published since that investigated the appropriate dose or monitoring for furosemide or its success as primary therapy for management of Targetmol‘s Methylcobalamin hypercalcemia of any cause.We found an orderly progression from placebocontrolled trials to comparisons of existing therapies and from the earliest agent, etidronate, to the more potent agents pamidronate, zoledronic acid, and ibandronate.The systematic review concluded that bisphosphonates are the drugs of choice for the treatment of hypercalcemia of cancer.This article reviewed studies that examined calcium normalization with the use of intravenous bisphosphonates.The investigators cited heterogeneity among the studies as preventing metaanalysis but identied normalization of calcium in greater than of patients with minimal side effects, which included fever and asymptomatic biochemical abnormalities.The use of loop diuretics should be restricted to those patients who are in danger of uid overload.Loop diuretics are not very effective in promoting signicant renal calcium excretion, and may provoke volume depletion when used in patients whose volume decit has not been reversed and who are not fully rehydrated. Today, IV bisphosphonates are the standard therapy for hypercalcemia of malignancy. Bisphosphonates have also been used in other causes of hypercalcemia, although the level of evidence is case reports or retrospective case series.Successful management of hypercalcemia with bisphosphonates has been reported in primary hyperparathyroidism, either in preparation for surgery or in nonsurgical candidates, although with a short duration of sell Methylcobalamin response; immobilization in patients undergoing obesity surgery, those with burns, and those with spinal cord injury. Reliance on historical precedent is not limited solely to the management of hypercalcemia; many therapies have become habit, often without supporting evidence.We may not know where such a habit came from and may struggle to nd its origin; however, that search may be informative and practicechanging.We argue that our search of furosemide studies is an example of the rst outcome.Because bisphosphonates require hours to take effect, it could be argued that furosemide still has a role in treatment of hypercalcemia during the rst few days.In contrast, calcitonin can effectively decrease the serum calcium level in as quickly as hours, and although tachyphylaxis limits prolonged use, it is perfectly suited for emergency management.Case reports and at least case control trial have studied the use of calcitonin in combination with various bisphosphonates.Our routine approach is saline hydration and bisphosphonates with subcutaneous calcitonin for severe symptoms.Renal failure has been a concern with bisphosphonate therapy, and some texts list nephrotoxicity as a complication; however, we found few reports in the literature, and most cases of renal insufciency occurred after repeated use for bone stabilization in cancer.
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