Metabolic Oncological Emergencies: Hypercalcemia Quiz

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Questions and Answers

Which of the following is NOT a presenting symptom highlighted in the 'bones, stones, moans, and groans' mnemonic?

Skeletal pain

Abdominal discomfort

Fever (correct)

Nephrolithiasis

What is the most reliable laboratory test to detect hypercalcemia?

Measuring albumin levels

Measuring total calcium

Measuring ionized calcium (correct)

Measuring parathyroid hormone levels

When measuring total calcium, which of the following is important to consider?

Correcting for renal function

Correcting for parathyroid hormone levels

Correcting for hypoalbuminemia (correct)

Correcting for hyperalbuminemia

What is the likely more significant factor in determining whether a patient becomes symptomatic from hypercalcemia?

The rate of calcium increase Signup and view all the answers

Which of the following is NOT a potential sign or symptom of hypercalcemia?

Tachycardia Signup and view all the answers

What is the effect of hypercalcemia on the QT interval?

Shortens the QT interval Signup and view all the answers

Which of the following can cause abdominal pain in the setting of hypercalcemia?

All of the above Signup and view all the answers

What is the relationship between hypercalcemia and kidney stone formation?

Even in the setting of profound hypercalciuria, not all patients will form kidney stones, which may be due to differences in the urine mineral concentration needed to precipitate calculi Signup and view all the answers

Which of the following cancers is least likely to cause hypercalcemia despite frequently metastasizing to bone?

Prostate cancer Signup and view all the answers

Which range is considered normal for serum calcium levels?

2.1-2.6 mmol/L Signup and view all the answers

Which of the following is the most common cause of hypercalcemia among hospitalized patients?

Malignancy Signup and view all the answers

Which of the following mechanisms can lead to hypercalcemia in cancer patients?

Bone metastases producing factors that stimulate osteoclasts, leading to bone resorption Signup and view all the answers

Which of the following statements is true regarding the symptoms of hypercalcemia?

The symptoms are non-specific, and delayed recognition can worsen morbidity and mortality Signup and view all the answers

Which of the following cancers is most likely to cause hypercalcemia through bone metastases?

Metastatic breast cancer Signup and view all the answers

Which of the following body systems can be affected by oncological emergencies?

All of the above Signup and view all the answers

Which of the following conditions is classified as a metabolic oncological emergency?

Hypercalcemia Signup and view all the answers

What is the role of measuring parathyroid hormone-related peptide (PTHrP) in initial management of hypercalcemia?

It has not been proven to affect outcome and should not guide initial management Signup and view all the answers

Which test is considered more readily available to support a diagnosis of humoral hypercalcemia?

Serum chloride levels Signup and view all the answers

What effect can PTHrP have on endogenous parathyroid hormone (PTH) levels in patients with humoral hypercalcemia?

Decrease PTH levels Signup and view all the answers

What is the cornerstone of initial management for hypercalcemia?

Hydration Signup and view all the answers

At what rate can normal saline be safely infused in a patient with hypercalcemia if they have intact left ventricular systolic function?

Up to 500 mls/hour Signup and view all the answers

Which medication can be initiated to promote calciuresis after volume depletion has been corrected in a patient with hypercalcemia?

Loop diuretics Signup and view all the answers

What is the suggested interval for administering furosemide intravenously in a patient with hypercalcemia for promoting calciuresis?

Every 12-24 hours Signup and view all the answers

When should urgent intervention be considered in a patient with hypercalcemia?

Urgent intervention is always needed regardless of calcium levels Signup and view all the answers

What is the mechanism by which antidiuretic hormone promotes free water uptake in the distal tubules?

Binding to the vasopressin 2 (V2) receptor Signup and view all the answers

What can contribute to continued free water intake in euvolemic hyponatremic patients with cancer?

Suppressed thirst mechanism Signup and view all the answers

Where is SIADH more commonly encountered based on the location of primary and metastatic tumors?

Lungs, pleura, thymus, and brain Signup and view all the answers

Which of the following cancers has a significant percentage of patients showing evidence of SIADH?

Small cell lung cancer Signup and view all the answers

Which of the following drugs can cause SIADH as an iatrogenic cause of hyponatremia?

Cisplatin Signup and view all the answers

How does SIADH primarily affect the extracellular fluid volume in euvolemic hyponatremic patients with cancer?

Reflects appropriate total sodium content but excessive water in intravascular space Signup and view all the answers

What is the primary issue with the thirst mechanism in euvolemic hyponatremic patients with cancer?

Insufficient inhibition of thirst mechanism Signup and view all the answers

What is the etiology of hyponatremia in patients receiving potentially causative medications such as cisplatin?

Platinum-induced salt-wasting nephropathy Signup and view all the answers

Which statement is true regarding the use of thiazide diuretics in managing hypercalcemia?

They should be avoided as they increase calcium reabsorption from the urine. Signup and view all the answers

Which of the following statements about hemodialysis is true, according to the text?

It may be a faster and less hazardous method of correcting hypercalcemia in patients with diminished kidney function. Signup and view all the answers

Which of the following statements is true regarding the use of glucocorticoids in managing hypercalcemia?

They are useful in mediating the release of cytokines and prostaglandins that stimulate osteoclasts. Signup and view all the answers

Which of the following nursing assessments is NOT mentioned in the text for managing hypercalcemia?

Auscultating lung sounds. Signup and view all the answers

Which of the following statements is true regarding fluid management in hypercalcemia?

Encourage fluid intake of 3 to 4 liters per day, including sodium-containing fluids (within cardiac tolerance). Signup and view all the answers

Which of the following nursing interventions is NOT mentioned in the text for managing hypercalcemia?

Administering supplemental oxygen therapy. Signup and view all the answers

Which of the following statements is true regarding the assessment of hyponatremia in cancer patients?

It requires a critical determination of volume status, as in all patients. Signup and view all the answers

Which of the following statements is NOT true based on the information provided in the text?

Thiazide diuretics are recommended for managing hypercalcemia. Signup and view all the answers

Study Notes

Hypercalcemia

Presents with skeletal pain, nephrolithiasis, abdominal discomfort, and altered mentation
Mnemonic: "bones, stones, moans, and groans"
Bone pain usually due to discrete metastasis rather than diffuse calcium liberation
Abdominal pain can arise from dysregulated intestinal motility, pancreatitis, or severe constipation
Changes in sensorium can occur along a spectrum from lethargy to coma
Hypercalcemia shortens QT interval and can produce cardiac arrhythmias
Other signs and symptoms include fatigue, lethargy, constipation, stupor, and coma

Diagnosis

Ionized calcium is the most reliable laboratory test to detect hypercalcemia (>1.29 mmol/L)
Total calcium levels should be corrected for hypoalbuminemia
No absolute level of calcium at which patients become symptomatic; rate of increase likely more significant than magnitude of elevation

Pathophysiology

Hypercalcemia affects up to one-third of cancer patients
Most common causes: breast, lung, and renal cell carcinomas; multiple myeloma; and adult T-cell leukemia/lymphoma
Bone metastases can cause local paracrine effect, leading to bone resorption and hypercalcemia
Prostate cancer rarely causes hypercalcemia

Management

Hydration is the cornerstone of initial management
Correction of volume depletion helps restore urine output
Loop diuretics can be initiated to promote calciuresis
Glucocorticoids can help mediate the release of cytokines and prostaglandins that stimulate osteoclasts
Hemodialysis may be a faster and less hazardous method of correcting hypercalcemia in patients with diminished kidney function

Nursing Management

Assess level of consciousness and neuromuscular status
Monitor cardiac rate and rhythm, and be aware of cardiac arrest risk
Monitor intake and output, and calculate fluid balance
Encourage fluid intake of 3-4 liters per day, including sodium-containing fluids
Promote frequent repositioning and range-of-motion exercises with caution

Hyponatremia

Assessment requires critical determination of volume status
Euvolemic hyponatremic patients have normal extracellular fluid volume but excessive water in the intravascular space
SIADH is suspected in patients with lung, pleura, thymus, or brain tumors
Iatrogenic causes of hyponatremia include cisplatin, cyclophosphamide, ifosfamide, vinca alkaloids, and imatinib

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Description

Test your knowledge on hypercalcemia, a high calcium level in the blood serum, as part of metabolic oncological emergencies. Learn about the normal range of calcium levels and the implications of hypercalcemia on the body systems.