Ikibazo cya Hypercalcemic Crisis of Malignancy cyangwa Hyperparathyroidism: Amagufa, Amabuye, Groans, Indwara zo mu mutwe, hamwe na Saline-Calcitonine¶

Ikibazo cya hypercalcemic (hypercalcemia ikomeye yibimenyetso) ni endocrine yangiza ubuzima hamwe nihutirwa rya oncologiya bisobanurwa na calcium ya calcium ya calcium yuzuye hejuru ya ** 14.0 mg / dL (3.50 mmol / L) **, cyangwa calcium ya serumu ionisiyoneri hejuru ya ** 10.0 mg / dL (2.50 mmol / L) **, hamwe na karisiyumu ikabije. ubukana bukabije bw'imitsi, umutima, cyangwa impyiko. Kurenga ** 90 ku ijana by'ibibazo byose bya hypercalcemic ** biterwa n'impamvu ebyiri gusa zitera: ** Hypercalcemia ya Malignancy ** (yibasira abagera kuri 20 kugeza 30 ku ijana by'abarwayi ba kanseri, cyane cyane ibihaha by'ingirabuzimafatizo, umutwe-ijosi, cyangwa kanseri ya Esophageal, kanseri y'impyiko, kanseri y'ibere, myeloma nyinshi, cyangwa HTLV-1 / Non-Hodgthy Crisis) ** uhereye kumikorere ya parathiyide adenoma cyangwa kanseri. Abaganga b’amavuriro bamenya syndrome ya sisitemu ya sisitemu ya mnemonic ** "Amagufa, Amabuye, Indwara yo munda, hamwe n’indwara zo mu mutwe (Overtones)" **: ** amagufwa ** (ububabare bwamagufwa ya osteolytike hamwe n’imvune za patologique), amabuye ** umunsi na ** byimbitse ya litiro 4 kugeza kuri 6 ya dehidrasi yo mu nda **), ** kuniha munda ** (isesemi idakira, kuruka, kuribwa mu nda, ibisebe byo mu nda, na ** acute hypercalcemic pancreatitis **), na ** imitekerereze y’indwara zo mu mutwe ** (intege nke z'imitsi, urujijo, imitekerereze ikabije, hamwe na coma) bradycardia, guhagarika umutima byuzuye, hamwe na fibrillation ya ventricular **. Niba umurwayi wese urwaye kanseri, indwara izwi cyane ya parathiyide, cyangwa vitamine D / calcium ikabije ifata ubunebwe bukabije, urujijo, inyota idahwema no kwihagarika, kuruka bidashoboka, cyangwa umutima utinda / udasanzwe, hamagara aho utuye nimero yihutirwa ako kanya. Ongera usubiremo abavandimwe bacu bayobora kuri syndrome ya tumor lysis (TLS) nyuma ya chimiotherapie, impyiko ibuye impyiko colic kandi ikabuza impyiko zanduye, na pancreatite ikaze, gutera gallbladder, hamwe na cholangite izamuka.

Icyihutirwa cyawe ni ugutwara umurwayi mubitaro byihutirwa kugirango ECG ihite ** 12-iyobowe na ECG (kugenzura niba intera yagabanijwe ya QTc hamwe no guhagarika umutima) ** na ** Albumin-Ikosowe + Ionize Kalisiyumu yamaraso **, tangira ** ako kanya, itera imitsi 0.9% Ubuzima busanzwe bwa Saline (1000 mL bolus ikurikirwa na 200 na 300 mL / saha) icyaricyo cyose cya diuretic **, hanyuma ukore ** Inkeragutabara Yihuta ya Pharmacologique: Subcutaneous / IM Salmon Calcitonin (4 kugeza 8 IU / kg buri masaha 6 kugeza 12, igabanya calcium mumasaha 4 kugeza kuri 6) icyarimwe ihujwe na Acide Intravenous Zoledronic (4 mg IV muminota 15) cyangwa igabanuka rya Denosumab (60 kugeza kuri 120 mg).

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa ako kanya niba umurwayi urwaye kanseri, hyperparathyideyide, cyangwa indwara ya granulomatique arwaye urujijo, gusinzira bikabije, kuruka bidashoboka, cyangwa intege nke zikomeye. nimero yihutirwa. Indwara ya hypercalcemia ikabije yihuta cyane kuva mubunebwe no kuvuga nabi kugeza koma, kunanirwa gukabije kwimpyiko, no gufatwa gutunguranye kwa bradycardic / ventricular.
2. ** Hita uhagarika imiti yose itera calcium ninyongera murugo no mubitaro: **
3. Hagarika ** inyongera ya calcium yo mu kanwa, antiside ya calcium ya karubone (* Tum *, * Rennie *, * Rolaide *) **, na ** Vitamine D / inyongera ya calcitriol **.
4. Hagarika ** Thiazide diuretics (hydrochlorothiazide, chlorthalidone, indapamide, metolazone) **, ihatira tubule yimpyiko ya kure kongera reabsorb calcium mumaraso.
5. Hagarika ** Litiyumu ** (ihindura parathiyide calcium-sensing reseptor igashyirwa hejuru) na ** Digoxin ** (hypercalcemia ikabije ikangurira imitsi yumutima kuri digoxine, ikagusha imitsi yica ** digoxin iterwa na arththmias yumutima no guhagarika umutima byuzuye **).
6. ** Niba umurwayi akangutse rwose, arikanuye, kandi ntaruke, shishikarizwa kunywa amazi meza munzira ijya mubitaro; niba ibitotsi, urujijo, cyangwa kuruka, komeza Ntakintu na kimwe kumunwa (NPO) hanyuma ushire mumwanya wo gukira kuruhande.
7. ** Menya neza ko Abaganga b’ibitaro babara Kalisiyumu yakosowe na Albumine (cyangwa Gupima Kalisiyumu Ionize Directeur) hanyuma bakabona ECG 12-Yayoboye Ako kanya. ** Kalisiyumu yakosowe na Album ya $ 13.8 inyandiko {mg / dL} $ **: $$ inyandiko {Kalisiyumu yakosowe (mg / dL)} = inyandiko {Yapimwe Ca yose (mg / dL)} + 0.8 inshuro ibumoso (4.0 - inyandiko {Serumu Albumin [g / dL]} iburyo) $$
8. ** Shimangira Kwinjira Kwinjira kwa 0.9% Ubusanzwe Amazi ya Saline (200 kugeza 300 mL / saha) Yambere, kandi NTUKIGERE Uha IV Furosemide (Lasix) Kugeza Kugabanuka kwa Volume Byuzuye. Guha diuretic ya loop kumurwayi wagabanutse cyane hypercalcemic umurwayi ** byangiza umwuma, bikagabanya umuvuduko wo kuyungurura glomerular (GFR), kandi byongera calcium ya tubular calcium reabsorption, bigatuma calcium yamaraso irushaho kwiyongera **. Indwara ya diuretique ikoreshwa * gusa * nyuma ya litiro ya saline isanzwe yagaruye euvolemia kandi mugihe ibimenyetso byamazi arenze urugero.
9. ** Administer Subcutaneous Calcitonin NA Acide Zoledronic Acide (cyangwa Subcutaneous Denosumab mu kunanirwa gukabije kw'impyiko) Hamwe mu Isaha Yambere. Gutanga ** Subcutaneous Salmon Calcitonin ($ 4 inyandiko {IU / kg} $ buri masaha 12) ** hamwe nikiraro cya Zoledronic Acide icyuho cyamasaha 48 ugabanya calcium ya calcium $ 1 inyandiko {kugeza} 2 inyandiko {mg / dL} $ mugihe cya ** 4 kugeza 6.

Igiti cyicyemezo: ikibazo gikomeye cya hypercalcemic triage hamwe nubuzima bwibitaro byibyiciro bitatu¶

flowchart TD
    A["Murebwayire Indwara mbi, Misa ya Parathiyide, cyangwa Indwara ya Granulomati Yerekana hamwe na Polyuria, Dehydrasiyo, Isesemi / Kuruka, Kuribwa mu nda, kubabara amagufwa, cyangwa urujijo / Lethargie"] --> B{"STAT Lab & ECG Tage: Gupima Kalisiyumu Ionize, Kalisiyumu Yuzuye + Serumu Albumin, Creatinine, PTH, Fosifore, na ECG-12"}
    B -->|Corrected Calcium >= 14.0 mg/dL (3.5 mmol/L) OR Calcium >= 12.0 mg/dL (3.0 mmol/L) WITH Neurologic, Cardiac (Short QTc / Heart Block), or Renal Symptoms| C["CYANE CYANE HYPERCALCEMIC: Kwinjira ako kanya ICU / Telemetry"]
    B -->|Mild (10.5 to 11.9 mg/dL) or Moderate Asymptomatic (12.0 to 13.9 mg/dL) with Normal Mental Status & Oral Intake| D["Umunwa / IV Hydrasiyo + Hagarika Thiazide / Kalisiyumu / Vit D + Ivuriro / Imirimo yo kuvura indwara ya PTH vs PTHrP"]
    C --> E["ICYICIRO CYA 1 (Isaha 0 kugeza 1): Hagarika Ca2 + / Vit D / Thiazides / Digoxin + Tangira Agressive IV 0.9% Saline isanzwe (1.000 mL bolus, hanyuma 200 kugeza 300 mL / hr kugirango ugere ku nkari zisohoka 100 kugeza 150 mL / hr; NTA Furosemide keretse Ubunini burenze urugero)"]
    E --> F["TIER 2"]
    F --> G{"TIER 3"}
    G -->|CrCl >= 30 to 35 mL/min: Standard Malignancy or Hyperparathyroid Crisis| H["Tanga IV ZOLEDRONIQUE 4 mg IV yashizwemo muminota 15 (cyangwa Pamidronate 60-90 mg IV hejuru yamasaha 2-4): Ihindura Ca2 + kumunsi wa 4 kugeza 7 kumunsi wibyumweru 3 kugeza 4"]
    G -->|Severe Renal Failure (CrCl < 30 mL/min) OR Bisphosphonate-Refractory Malignancy| I["Tanga Subutaneous DENOSUMAB 60 kugeza 120 mg (Antibody ya RANKL: Ntabwo ikuweho nimpyiko. Ikosore ibura rya Vitamine D / ukurikiranire hafi kuri hypocalcemia ikabije nyuma ya dose)"]
    G -->|Lymphoma, Sarcoidosis, Tuberculosis, or Vitamin D Toxicity (1,25-Dihydroxyvitamin D Mediated)| J["Ongeramo umunwa / IV GLUCOCORTICOIDS: Hydrocortisone 200-400 mg / kumunsi IV CYANGWA Prednisone 40-60 mg / kumunsi PO (Irabuza macrophage 1-alpha-hydroxylase muminsi 2 kugeza 5)"]
    H --> K{"Ese Kalisiyumu> 18 kugeza kuri 20 mg / dL (4.5 mmol / L) HAMWE NA Koma, Kunanirwa k'umutima (Ntushobora kwihanganira Saline), cyangwa kunanirwa kw'impyiko za Oliguric?"}
    I --> K
    J --> K
    K -->|YES: Life-Threatening Refractory Crisis| L["HEMODIALYSIS YIHUTIRWA ukoresheje Kalisiyumu nkeya cyangwa Zeru-Kalisiyumu Dialysate Yoga"]
    K -->|NO: Urine Output >= 100 mL/hr & Calcium Trending Down| M["Ongera Potasiyumu & Magnesium (Saline diuresis isesagura K + na Mg2 +); Tegura Parathyroidectomy (niba HPT ibanza) cyangwa Chimiotherapie"]

Indwara ya Pathophysiologiya: kuki calcium nyinshi itera litiro 4 kugeza kuri 6 ya dehydrasiyo ("Kalisiyumu iterwa na Diyabete ya Nephrogenic Diabete Insipidus")¶

Abantu benshi bibwira ko umurwayi ufite calcium nyinshi akenera gusa diuretique kugirango asohore calcium hanze. Mubyukuri, ** hypercalcemia ubwayo ikora nka diureti ikomeye, idateganijwe igabanya umwuma umurwayi kuri litiro 4 kugeza kuri 6 (litiro 1 kugeza kuri 1.5) y'amazi mbere yuko bagera mubitaro **:

THE VICIOUS SPIRAL OF HYPERCALCEMIC NEPHROGENIC DIABETES INSIPIDUS
=======================================================================
   [High Blood Calcium (> 12 to 14 mg/dL)]
                      |
                      +---> 1. Activates Calcium-Sensing Receptors (CaSR)
                      |        on the Thick Ascending Loop of Henle
                      |        (Blocks Na-K-2Cl cotransporter, mimicking
                      |         a non-stop Loop Diuretic -> Salt & Water loss)
                      |
                      +---> 2. Downregulates Aquaporin-2 Water Channels
                               in the Renal Collecting Duct
                               (Kidneys become blind to Antidiuretic Hormone
                                [ADH] -> NEPHROGENIC DIABETES INSIPIDUS)
                                              |
                                              v
                    Massive Polyuria (4 to 8 Liters of Dilute Urine/Day)
                    + Hypercalcemic Nausea & Vomiting (Cannot Drink Water)
                                              |
                                              v
                    PROFOUND INTRAVASCULAR DEHYDRATION (4 to 6 Liter Deficit)
                                              |
                      +-----------------------+-----------------------+
                      |                                               |
                      v                                               v
        Renal Afferent Arterioles Constrict              Proximal Renal Tubule Avidly
        --> Glomerular Filtration Rate (GFR)             Reabsorbs Sodium AND Calcium
            Plummets (Kidney Filters Less Ca2+)          Back Into the Bloodstream.
                      \                                               /
                       \                                             /
                        v                                           v
                         SERUM CALCIUM SKYROCKETS ABOVE 15-18 mg/dL.
=======================================================================

Nigute 0.9% Saline isanzwe imena Spiral mbi¶

Iyo abaganga b'ibitaro bashizemo ** isotonic 0.9% Sodium Chloride (Saline isanzwe) kuri 200 kugeza 300 mL / isaha **: 1. ** Kugarura igipimo cya Glomerular Filtration (GFR): ** Kwagura ingano yimitsi itwara imitsi byongera gufungura amaraso yimpyiko bityo calcium ikongera kuyungurura muminkari. 2. ** Sodium Ifunga Kalisiyumu Yuzuye ya Reabsorption (Natriuresis Iringana na Calciuresis): ** Muri tubule yegeranye yuzuye impyiko, ** calcium na sodium reabsorption ihujwe cyane **. Kwuzuza impyiko na sodium ya ** ($ Na + $) ** itegeka tubule yegeranye guhagarika reabsorbing sodium, ihita ihagarika guhagarika calcium, ikajugunya $ 1.5 inyandiko {kugeza} 2.5 inyandiko {mg / dL} $ ya calcium irenze igahita yinjira mu nkari.

Uburyo bune bwibibazo bya hypercalcemic: laboratoire kuruhande no gutandukanya amavuriro¶

Amaraso amaze gukururwa mu ishami ryihutirwa rya ** Hormone Yuzuye ya Parathiyide (iPTH), Poroteyine ifitanye isano na Parathiyide Hormone (PTHrP), 25-hydroxyvitamine D, na 1,25-dihydroxyvitamine D (calcitriol) **, impamvu nyayo itera ikibazo cya hypercalcemic igwa muri imwe mu ndobo enye zifata umubiri:

Ibimenyetso byinshi byamavuriro nibimenyetso bya ECG biranga ikibazo cya hypercalcemic¶

1. Sisitemu enye zingingo ("Amagufa, Amabuye, Groans, na Overtones zo mu mutwe")¶

1. ** Neurological & Neuromuscular ("Psychiatric Overtones"): ** Kubera ko calcium yo mu bwoko bwa calcium yo mu kirere idasanzwe izamura imbaraga z'umubyigano zisabwa kugira ngo zishire imiyoboro ya sodium kuri neuron n'imitsi ya skeletale (stabilite membrane na ** itesha umutwe neuromuscular ishimishije **, bihabanye rwose na hypocalcemic tetany), abarwayi bafite uburibwe bukabije bwimitsi, hyporeflexia (hyporeflexia); paranoia / hallucination, kuvuga nabi, gutitira, na coma ** (cyane cyane iyo calcium ikosowe irenga $ 14 inyandiko {kugeza} 15 inyandiko {mg / dL} $).
2. ** Impyiko ("Amabuye & Polyuria"): ** ** Indwara ya diabete ya Nephrogène insipidus ** (inyota idahwema [polydipsia] hamwe n'inkari [polyuria]), kugabanuka gukabije, calcium oxalate / fosifate nephrolithiasis (ububabare bwa flank), nephrocalcinose, na ** gukomeretsa impyiko **.
3. ** Gastrointestinal ("Groans Abdominal"): ** Imitsi yoroshye mu nzira ya GI ihinduka hypotonic kandi itinda, itera ** anorexia, isesemi idakira no kuruka, kubangamira cyane / kuribwa mu nda, no kubabara mu nda . Byongeye kandi, calcium nyinshi itera irekurwa rya gastrine ( peptic ulcer disease **) kandi ikora trypsinogen imburagihe imbere mungirangingo ya pancreatic acinar, itera ** acute necrotizing pancreatitis **.
4. ** Imitima Yumutima & 12-Iyobora ECG Impinduka: **
5. ** Bigufi QT / QTc Intera: ** Kalisiyumu nyinshi yihutisha icyiciro cya 2 cya plateau repolarisation yubushobozi bwibikorwa byumutima, gukurura T-wave hejuru yinyuma yikigo cya QRS (** kugabanya igice cya ST no kugabanya intera ya QTc $ <340 inyandiko {kugeza} 360 inyandiko {ms} $ **).
6. ** Osborn Waves (J-Waves) mu barwayi ba Normothermic: ** Ku rwego rwa calcium iri hejuru ya $ 14 inyandiko {kugeza} 16 umwandiko {mg / dL} $, gutandukana kwiza kuri J-point (** Osborn wave **, bikunze kugaragara muri hypothermie ikabije) bigaragara kuri ECG, bigana infarction ya ST-hejuru.
7. ** Bradyarrhythmias na Block Block: ** Urwego rwa mbere, urwego rwa kabiri, cyangwa ** rwuzuye (urwego rwa gatatu) AV yumutima wumutima **, ishami ryumutwe wa bundle, ifatwa rya sinus, hamwe na fibrillation itunguranye **.

Intambwe ku yindi Ibitaro bya Farumasi Porotokole: Guhuza Byihuta-Byihuse hamwe nubuvuzi bumara igihe kirekire¶

Kuberako nta muti numwe ugabanya calcium yamaraso byombi ** byihuse (mumasaha) ** na ** biramba (kumyumweru) **, amabwiriza asanzwe yatanzwe na ** Endocrine Society ** na ** ASCO ** manda yo gutangiza ** uburyo butatu bwo kuvura icyarimwe ** kumasaha 0:

TIMELINE OF ACTION: WHY CALCITONIN AND ZOLEDRONIC ACID ARE GIVEN TOGETHER
=======================================================================
Serum
Ca2+
16 mg/dL |\
         | \  [TIER 1: IV 0.9% Normal Saline (200-300 mL/hr)]
14 mg/dL |  \  Starts working immediately via hemodilution & natriuresis
         |   \ (-1.5 to -2.5 mg/dL over 12-24 hrs)
         |    \
12 mg/dL |     \___[TIER 2: SubQ Salmon CALCITONIN (4-8 IU/kg q6-12h)]
         |         Rapidly drops Ca2+ in 4 to 6 HOURS (-1 to -2 mg/dL),
         |         but STOPS WORKING at 48 hours (receptor tachyphylaxis).
10 mg/dL |                  \__________________________________________
         |                   [TIER 3: IV ZOLEDRONIC ACID (4 mg) or DENOSUMAB]
         |                    Takes 48 to 72 HOURS to start working, reaches
         |                    peak nadir at Day 4 to 7, and lasts 3 to 4 WEEKS.
         +-------------------------------------------------------------
         Hour 0   Hour 6   Hour 24   Hour 48   Day 4          Day 21-28
=======================================================================

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

• ** Amerika na Kanada: ** Hamagara ** 911 ** ako kanya kuri kanseri iyo ari yo yose cyangwa umurwayi wa parathiyide ufite urujijo, ubunebwe bukabije, kuruka bidashoboka, cyangwa ibimenyetso byumutima. Kurikiza ** Amabwiriza ya Sosiyete Endocrine Amabwiriza yubuvuzi bwa Hypercalcemia ya Malignancy (2023) ** na ** NCCN ** protocole: ako kanya IV 0.9% hydrata ya saline isanzwe + SubQ calcitonin + IV acide acide cyangwa SubQ denosumab.
• ** Ubwongereza: ** Hamagara ** 999 ** kubera urujijo rukabije, koma, cyangwa umutima utera umutima, cyangwa ubaze ibitaro byawe ** amasaha 24 yumurongo wa serivisi ya Acute Oncology Service (AOS) **. Munsi ya ** Sosiyete ishinzwe Endocrinology (UK) Amabwiriza yihutirwa kuri protocole Acute Hypercalcaemia ** na ** NICE **, abarwayi bafite calcium yakosowe $> 3.0 inyandiko {mmol / L} $ ($ 12.0 inyandiko {mg / dL} $) cyangwa ibimenyetso byakira litiro 4 kugeza kuri 6 za IV 0.9% sodium chloride mu masaha 24 ** ikurikirwa na ** IV pamidronate.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: ** Hamagara ** 112 ** mu bihugu byose bigize Umuryango w’ubumwe bw’ibihugu by’Uburayi. Amashami ya Oncology na endocrinology akurikiza ** Umuryango w’uburayi ushinzwe ubuvuzi Oncology (ESMO) ** na ** Umuryango w’ibihugu by’i Burayi bya Endocrinology (ESE) ** amabwiriza yihutirwa.
• ** Australiya na Nouvelle-Zélande: ** Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande. Kurikiza ** eviQ (Ikigo cya Kanseri NSW) ** na ** Amabwiriza yo kuvura (Ositaraliya) ** kuri hypercalcemia ya malignance.
• ** Aziya-Pasifika: ** Hamagara ** 119 ** mu Buyapani no muri Koreya y'Epfo, ** 995 ** muri Singapuru, ** 999 ** muri Maleziya na Hong Kong, cyangwa ** 112/108 ** mu Buhinde kugira ngo bitware ibitaro byihuse.

Ibibazo bikunze kubazwa¶

Kuki calcium nyinshi yamaraso ituma umuntu agira umwuma mwinshi niba arimo kwihagarika umunsi wose?¶

Kalisiyumu nyinshi mu maraso yangiza mu buryo butaziguye imashini yibanda ku mazi y'impyiko, bigatera indwara yitwa calcium iterwa na diyabete ya neprogeneque insipidus. By'umwihariko, calcium irenze ikora calcium-sensing reseptors muri Loop ya Henle (ikora nka diuretique idahagarara ita umunyu n'amazi) ikabuza imiyoboro y'amazi ya Aquaporin-2 mumiyoboro ikusanya kugirango impyiko zidashobora kongera kwitabira imisemburo ya antidiureti (ADH). Kubera iyo mpamvu, umurwayi yihagarika litiro 4 kugeza kuri 8 zamazi meza, yoroheje buri munsi mugihe icyarimwe ahura nisesemi ikabije ya hypercalcemic no kuruka bibabuza kunywa amazi ahagije kugirango akomeze, asigare litiro 4 kugeza kuri 6.

Ni ukubera iki ari bibi ko abaganga batanga IV furosemide (Lasix) ako kanya kugirango basohore calcium nyinshi?¶

Mu myaka icumi ishize, ibitabo byubuvuzi byigishije abaganga gutanga umunyu usanzwe hamwe na furosemide ikabije ya IV ako kanya kugirango bahatire impyiko gusohora calcium. Ubushakashatsi bw’ubuvuzi bwaje kwerekana ko gutanga diureti ya loop nka furosemide mbere y’uko umurwayi wa litiro 4 kugeza kuri 6 ya dehidrasi yuzuye yujujwe burundu na saline isanzwe biteje akaga: byangiza umwuma, bigabanya amaraso y’impyiko (GFR), kandi bigahatira igituba cyegereye impyiko kongera gukora sodium ndetse na calcium nyinshi mu maraso, bigatuma hypercalcem iba mbi cyane. Uyu munsi, furosemide irahagarikwa rwose kugeza igihe imitsi yimitsi itagaruwe neza hamwe na litiro ya 0.9% yumunyu usanzwe, kandi ikoreshwa gusa mugihe umurwayi afite umuvuduko ukabije.

Kuki abaganga bagomba kubara "Kalisiyumu yakosowe na Albumin" mu barwayi ba kanseri?¶

Hafi ya 40 kugeza 45 ku ijana bya calcium yose ireremba mumaraso yawe byanze bikunze biterwa na poroteyine zitwara abantu, cyane cyane alubumu, mugihe 50% isigaye ari ubuntu, ikora mubinyabuzima "calcium ionisiyumu." Gusa calcium yubusa ya calcium igira ingaruka mubwonko bwawe, umutima, nimpyiko. Abarwayi benshi barwaye kanseri yateye imbere cyangwa uburwayi budakira bafite amaraso make ya alubumu (hypoalbuminemia) kubera imirire mibi cyangwa gutwikwa. Iyo alubumu iri hasi, ikizamini cya laboratoire "calcium yuzuye" gisa nubushukanyi cyangwa hejuru gusa byoroheje nubwo mugihe calcium yubusa ionisiyumu yubusa iba mwijuru. Wongeyeho 0.8 mg / dL kuri calcium yose kuri buri 1.0 g / dL ko serumu albumin igwa munsi ya 4.0 g / dL (cyangwa gupima calcium itaziguye) byerekana uburemere bwikibazo.

Ni ukubera iki abaganga batanga Calcitonine Subcutaneous na Acide Zoledronic Acide icyarimwe?¶

Acide Zoledronic Acide (bisphosphonate ikomeye) na Subcaneous Denosumab niwo muti ukomeye cyane wo guhagarika kumeneka amagufwa no gutuma calcium yamaraso isanzwe mugihe cibyumweru 3 kugeza 4, ariko bifata amasaha 48 kugeza kuri 96 (iminsi 2 kugeza 4) kugirango batangire gukora. Ku rundi ruhande, Salmon Calcitonin yo mu bwoko bwa Subcutaneous itangira kugabanya calcium yamaraso mu masaha 4 kugeza kuri 6 gusa, ariko ihagarika gukora rwose nyuma yamasaha 48 kuko selile yamagufwa ihisha vuba reseptor ya calcitonine (tachyphylaxis). Gutanga imiti yombi hamwe kumasaha 0 ikoresha Calcitonin ikora byihuse nkikiraro gikiza ubuzima amasaha 48 kugeza igihe Acide Zoledronic Acide cyangwa Denosumab itangiye kumunsi wa 3.

Nigute isuzuma ryoroshye rya Parathiyide Hormone (PTH) ribwira abaganga niba calcium nyinshi iterwa na kanseri cyangwa ikibyimba cya parathiyide?¶

Muri Primary Hyperparathyroidism, imwe muri glande enye za parathiyide mu ijosi yateje ikibyimba cyiza (adenoma) cyangwa hyperplasia yigenga isohora cyane Parathiyide Hormone (PTH), bityo ikizamini cya laboratoire cyerekana calcium nyinshi yamaraso KANDI murwego rwo hejuru (cyangwa rudakwiye). Muri Hypercalcemia ya Malignancy, kanseri izamura calcium mu maraso haba mu gusohora imisemburo yigana yitwa PTHrP (itiyandikisha ku buryo busanzwe bwa laboratoire ya PTH) cyangwa mu gushonga amagufwa, kandi glande nziza ya parathiyide mu ijosi yumva calcium yo mu kirere yuzuye kandi igahagarika umusaruro wa PTH uri munsi ya 10 kugeza kuri 20.

"Amagufa, Amabuye, Inda zo munda, hamwe na Overtones zo mu mutwe" bisobanura iki?¶

Iyi nteruro yubuvuzi ya kera yerekana incamake yuburyo bune bwibasiwe na hypercalcemia: "Amagufa" bivuga ububabare bukabije cyangwa kuvunika indwara ya calcium biva muri calcium biva muri skeleton (osteitis fibrosa cystica cyangwa osteolytic metastase); "Amabuye" bivuga amabuye y'impyiko ya calcium na diyabete ya neprogeneque insipidus dehydration; "Abdominal Groans" bivuga igogora rikabije, isesemi, kuruka, ibisebe bya peptike, na pancreatite ikabije ya hypercalcemic; na "Indwara zo mu mutwe" (cyangwa "Induru") bivuga kwiheba, umunaniro ukabije, kubura kwibuka, urujijo, salusitike, na koma kuko calcium nyinshi itinda kwanduza imitsi mu bwonko.

Inkomoko nubuyobozi¶

• ** Umuryango wa Endocrine (Amerika): ** * Kuvura Hypercalcemia ya Malignance mu Bakuru: Amabwiriza ya Clinical Practice Society ya Endocrine Sosiyete (2023) *
• ** Sosiyete ishinzwe Endocrinology (Ubwongereza): ** * Sosiyete ishinzwe Endocrinology Endocrine Ubuyobozi bwihutirwa: Ubuyobozi bwihutirwa bwo kuvura Hypercalcaemia ikaze ku barwayi bakuze * (litiro 4 kugeza kuri 6 0.9% protocole yubuzima bwa NaCl na dose ya bisphosifone).
• ** Urwego rw’igihugu rushinzwe kanseri (NCCN) na Sosiyete y'Abanyamerika ya Oncology Clinical Oncology (ASCO): ** * Imicungire y’ibihe byihutirwa bya Onabologiya: Hypercalcemia ya Humoral na Osteolytic ya Malignancy *.
• ** Ishyirahamwe ryabanyamerika ryokubaga Endocrine (AAES): ** * Amabwiriza asobanutse ya Hyperparathyroidism yibanze no gucunga ibibazo bya parathiyide ikaze *.
• ** Ikinyamakuru gishya cy’ubuvuzi cy’Ubwongereza (NEJM) Isubiramo ry’ubuvuzi (Stewart AF; Guise TA, Wysolmerski JJ): ** * Ubuvuzi: Hypercalcemia Yifatanije na Kanseri *.

Kuyobora¶

• Indwara ya Tumor lysis (TLS) nyuma ya chimiotherapie cyangwa steroid
• Impyiko yamabuye yimpyiko kandi ikabuza impyiko zanduye
• Indwara ya pancreatite ikaze, gutera gallbladder, hamwe na cholangite izamuka
• Indwara ya vena cava isumba izindi (SVC) hamwe na tamponade mbi ya pericardial
• Imibare yihutirwa ukurikije igihugu