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Assisi-LCPC Palliative Care Course for Nurses
BooST ICU: Boosting Supportive Care Training for the ICUs
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Common Serious Neurological Conditions 101
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Delphi Study on Objectives, Outcomes, and Consensus-based Definition for ACP Interventions
Implementation of SIC Program
My Voice (Cancer)
My Voice (Heart)
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National Evaluation of ACP 3.0
CONCORD
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Palliative Care Health Coaching for Heart Failure Patients and their Caregivers
TIER with Heart Failure Patients
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APAC Ageing and Caregiving Survey
APPROACH-2
Delphi Study on Quality of Care for Individuals with Dementia in Asia
Global Delphi Study on Consensus-based Indicators for Quality of End-of-Life Care
Paediatric Healthcare Worker Burnout and Empathic Distress Fatigue
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肾衰竭
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Optimising Outpatient Follow-Up to Reduce 30-day Hospital Readmissions
End Of Life Utilisation And Costs Palliative Care Advanced Cancer
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高钙血症 (Hypercalcaemia)
SG-Pall-電子書
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慈怀疗护中的紧急情况
高钙血症 (Hypercalcaemia)
EN
中文
简介
高血钙症是影响多达三分之一癌症患者的常见代谢疾病。
这是恶性疾病的不良预后指标。
恶性的原因包括骨质溶解,体液介质,脱水和肿瘤特异性机制
非恶性的原因包括原发性甲状旁腺功能亢进症,脱水,结核,结节病,某些药物(如锂)和使用过量的钙/ 维生素 D补充剂
症状和体征
大多数症状基本上是不明显的。
急性症状的发生通常是因为钙水平迅速升高。
典型的症状被形容为“抱怨、呻吟、骨头问题、结石问题”。
症状
迹象
疲劳
昏昏欲睡
恶心和呕吐
谵妄(精神错乱)
厌食症
癫痫发作
腹痛
心律失常
便秘
体位性低血压
一般酸痛和疼痛
肾结石
口干舌燥/多尿
检查
校正钙浓度(测定校正的血清钙浓度)
校正血清鈣水平> 2.6mmol / L =高钙血症
校正血清鈣水平> 3.0mml / L = 需要紧急处理
尿素和电解质
高钙血症中脱水和电解质紊乱非常常见
血浆甲状旁腺激素(PTH)
如果怀疑是非恶性的高钙血症
血浆甲状旁腺激素在恶性高钙血症中被会被抑制
心电图
心律失常
扩大QRS波,延长PR间隔
应对方法
补液
补液是最重要的。它有助于恢复肾功能和增加钙的排泄
大多数患者有4至6公升的体液不足。 如果没有禁忌症,每天补充2到3公升静脉输液
双膦酸盐 (Bisphosphonates)
在开始静脉注射双膦酸盐之前确保有攝入充足水份
对肾功能损害的患者需要减少剂量。对于肌酐清除率(CrCl) <30mls / 分钟的患者,应征求专家的建议
药效发挥作用大约是48小时内,血清鈣水平持续下降直到大约第7天
帕米膦酸盐(Pamidronate)和佐来膦酸盐(Zoledronate)同样有效
如果需要,上述药物可每3-4周重复使用
常见的副作用包括暂时性发烧和肌痛
牙齿排列不良或近期有牙科问题的患者可能需要清除牙齿,特别是如果使用高剂量并且长时间使用此药,它会增加颌骨坏死的风险
降钙素(Calcitonin)
4个单位/公斤,一天两次
可将血清钙水平降低0.3-0.5mmol / L
4小时快速发挥作用
快速抗药反应通常发生在48小时后,届时可停用降钙素
一般用于钙浓度> 3.5mmol / L以降低血清鈣水平,同时等待双膦酸盐(Bisphosphonates)和补水生效。
狄诺塞麦(Denosumab)
被认为与双膦酸盐(Bisphosphonates)治疗高钙血症一样有效
此药不通过肾脏排泄,所以可用于肾功能衰竭患者,但需要调整剂量
参考资料
Lamy O, Jenzer-Closuit A, Burckhardt P. Hypercalcaemia of malignancy: An undiagnosed and undertreated disease.
Journal of Internal Medicine.
2001;250(1):73–79.
Chan KS, Tse DMW, Sham MMK, Thorsen AB. Palliative medicine in malignant respiratory diseases. In Hanks G, ed.
Oxford Textbook of Palliative Medicine.
4TH ed. Oxford, NY: Oxford University Press; 2010:1007–1144.
Endocrine system and immunomodulation. In Twycross R, ed.
Palliative Care Formulary.
4TH ed. Nottingham, UK: palliativedrugs.com Ltd; 2011:469–524.
Dietzek A, Connelly K, Cotugno M, Bartel S, McDonnell AM. Denosumab in hypercalcemia of malignancy: A case series.
J Oncol Pharm Pract.
2014;21(2):143–147.
Berenson JR. Treatment of hypercalcemia of malignancy with bisphosphonates.
Semin Oncol.
2002;29(6 Suppl 21):12–18.
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