Objective Hypercalcaemia of malignancy is a palliative care emergency that needs early intervention. Bisphosphonate therapy improves the morbidity of acute hypercalcaemia, reduce bone pain and pathological fractures. North of England Cancer Network Palliative Care Guidelines suggests early admission, rehydration followed by bisphosphonate therapy (if appropriate). We assessed the hypercalcaemia management at hospice setting and adherence to regional guidelines.
Materials and methods Retrospective data of all patients admitted with hypercalcaemia at Hartlepool hospice (January 2010–December 2010) was collected with regard to baseline demographics, calcium level, management and follow-up planning. Further analysis was done to assess whether regional guidelines were followed.
Results A total of 22 patients were admitted with hypercalcaemia during the study period. Median age (range) was 68 (52–84) years and Male to female ratio was 1:1. The top five common cancers were lung (5), breast (5), prostate (3), bowel (3) and head and neck (2). Patients with mild (2.6–3.0 mmol/l), moderate (3.0–3.5 mmol/l) and severe (>3.5 mmol/l) hypercalcaemia were 18, 3 and 1 respectively. Most common presenting symptom was pain (36%) and nausea (36%). Symptomatic hypercalcaemia was treated in 88% of patients. Intravenous fluid therapy was given in 65% of patients with symptoms. Bisphosphonate therapy was given in 88% of patients with symptoms and after intravenous fluids in 27% of patients. Symptomatic improvement is noted in 56% of patients. Post-treatment calcium level was checked in 70% of patients. Recommendations were intravenous fluid therapy with 1–2 l normal saline to be given before Zolendronic acid (if not contraindicated). Repeat calcium levels at 5 days and 3 weeks. Furthermore, strict documentation of all events including symptomatic improvement was recommended.
Conclusion Hypercalcaemia in palliative care setting is a common problem and must be treated according to the standard regional guidelines. Follow-up audit has been planned after implementation of recommendations.
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