Download - Immobilization Hypercalemia
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Immobilization HypercalcemiaAndrew N. Antonio, OTSUniversity of St. Augustine
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OverviewDefinitionEtiology and pathophysiologyCharacterize the condition as it
relates SCIProsed ManagementCase ReviewQuestions
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Hypercalcemia
“Hypercalemia results when the accelerated bone resorption exceeds the capacity of the kidneys to filter calcium.”
Massagli & Cardenas, 1999
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CalciumRegulation and processes of body
functionsRegulation
◦Parathyroid hormone (PTH)◦Vitamin D◦Calcitonin
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HypercalcemiaMild (Ca+ <12 mg/dl)Moderate (Ca+ between 12 and
14 mg/dl)Severe (Ca+ >14 mg/dl)
Diagnosed via blood test
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EtiologyMain cause is hyperparathyroidism
(>90%)◦Common in women over 50 y/o
Malignancies may be associated (20%)Inherited kidney or metabolic
conditionsExcessive Vitamin D & AAluminum intoxicationMilk-Alkali SyndromeImmobilization
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Immobilization Hypercalcemia
Acute spinal cord injury (10-23%)Often in male adolescents/ young
adultsTetraplegia v. paraplegiaIncrease bone resorptionLoss of trabecular bone volumeDecreased osteoblastic bone
formationDepressed parathyroid hormone
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Immobilization Hypercalcemia cont.Develops within days to months of
immobilization~4 - 8 weeks after
Last weeks to monthsHypercalciuria
◦Within 1st week up to 6-18 months
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Signs and SymptomsFatigueConstipationAnorexiaNauseaAlteration in moodVomitingLethargyPolydipsiaPolyuria Intravascular volume depletionHypertensionArrythmias
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TreatmentGoal:
◦ Decrease serum Ca+ concentration◦ Underlying disease
HydrationLoop Diuretics (i.e. furosemide)BiphosphonatesAntineoplastic DrugsAntidote, hypercalcemia agentsGlucocorticoidsMineralsCalcimimetic AgentSurgical treatment
Massagli & Cardenas, 1999
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Zoledronic Acid Biphosphonate Ca+ Regulator Reduces risk for Fx Once-yearly injection 100-850 times more potent than Pamidronate Paget’s disease, osteoporosis Side effects
◦ Flu-like symptoms (within 3 days)◦ Fever◦ Headache◦ Muscle spasm◦ Severe muscle, joint or bone pain◦ Decrease urination level and frequency◦ Hypertension◦ *Jaw problems
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Rehabilitation Team“Moans”, “Stones”, “Groans” &
“Bones”Early RemobilizationActive movementWeight bearingUpdate on medical statusIncrease fluid intakePatient/ family/ caregiver
education Massagli & Cardenas, 1999
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Crown et al. American Journal of Clinical Medicine, 2009
46 y/o female Stopped by airport police for erratic Bx Hx of hypertension, alcohol abuse, Hep B Presenting symptoms: generalized confusion, lethargy,
hypertension Physical exam unremarkable with no focal motor or sensory
deficits, cont. altered mental status Progressed to abdominal pain, severe constipation,
bradycardia, electrolyte imbalance
Findings: Altered state & acute pancreatitis due to hypercalcemia Hypomagnesia & acute renal failure due to dehydration
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Massagli et al. Arch Phys Med Rehabilitation, 1999
9 patients with immobilization
hypercalcemia◦7 men, 2 women◦Mean age 22 y/o◦Onset ranged from 3 – 16 weeks
Pamidronate DisodiumEffectiveness, duration of Tx, and ease of
administration appear promisingLess interruption of activities Excellent response, with few complicationsOf 78% of the pts., only one treatment
needed
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SummaryAcute SCIDifficult to detect early More in male adolescents and
younger adultsVarying levels of severityCannot be preventedAim to restore Ca+ levels, and treat
underlying diseaseMobilization and weight bearingMedications or injection
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ReferencesAgrharkar, M. (2014). Hypercalcemia Medication. Retrieved
December 5, 2014, from http://emedicine.medscape.com/
American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683.
Crown et. al. (2009) Hypercalcemic crisis: a case study. American Journal of Clinical Rehabilitation. 6(1), 38-40.
Kolnick et. al (2011). Hypercalcemia in Pregnancy: A case of milk-alkali syndrome. Retrieved December 1, 2014 from http:// ncbi.nlm.nih.gov/
Massagli, T. & Cardenas, D. (1999) Immobilization hypercalcemia treatment with pamidronate disodium after spinal cord injury. Arch Phys Med Rehabilitation. 80(2), 998-1000
Shane, E. & Berenson, J. (2014). Treatment of Hypercalcemia. Retrieved December 4, 2014, from http://uptodate.com/
Zoldronic Acid (Injection). (2014). Retrieved December 16, 2014, from https://www.ncbi.nlm.nih.gov/pubmedhealth/
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Questions?