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■ Nausea and vomiting
■ Paralytic ileus
■ Constipation
■ Polyuria (early sign)
■ Kidney stones
■ Severe muscle weakness
■ Loss of deep-tendon reflexes
■ More severe changes: dehydration, ECG changes (shortened QT interval)
■ CNS changes
■ Seizures
■ Coma
Diagnostic Tests
■ Parathyroid hormone levels
■ BMP every 6 hr
■ Ca 2 + levels
Management
■ Provide oral hydration.
■ Provide IV hydration with normal saline.
■ Administer medications to decrease Ca 2 + levels temporarily.
■ Administer glucocorticoids: prednisone or hydrocortisone.
■ Administer calcitonin (Miacalcin, Osteocalcin).
■ Administer bisphosphonates: pamidronate (Aredia), etidronate (Didronel),
alendronate (Fosamax).
■ Administer gallium nitrate (Ganite).
■ Consider IV phosphate and cinacalcet (Sensipar).
■ Dialysis may be indicated to decrease serum Ca 2 + levels in life-threatening
situations or in patients with renal impairment.
Superior Vena Cava Syndrome (SVCS)
SVCS occurs when the SVC is compressed or obstructed by tumor growth →
painful life-threatening emergency, most often seen in patients with breast cancer,
lymphoma, prostate cancer, and lung cancer, especially mediastinal malignan-
cies. SVCS results in blockage of blood flow in the venous system of the chest,
neck, and upper trunk. SVCS is also common in patients with intravascular
devices and in hypercoagulability syndromes.
Clinical Presentation
Early Symptoms
■ Edema of the face, especially around the eyes, when patient arises from
night’s sleep
■ Dysphagia, cough, and hoarseness
■ Tightness of shirt or collar (Stokes’ sign) as compression worsens
HEMA/
ONCO