Are diuretics effective and safe in managing managing with hypercalcemia in the hospital setting?

Bottom line:  There is no direct evidence to support the use of diuretics in managing patients with hypercalcemia  Hydration with normal saline and immediate administration of bisphosphonate therapy is treatment of choice.  Subcutaneous calcitonin may be used in patients with severe symptoms.
Summary:  LeGrand SB, et al.  Narrative review: furosemide for hypercalcemia: an unproven yet common practice.  Ann Intern Med. 2008 Aug 19;149(4):259-63.
According to this review of evidence in Medline, there are 9 studies comprising 35 patients that document the use of furosemide in managing hypercalcemia.  The review also identified studies in Medline that documented the effectiveness of bisphosphonates in treating hypercalcemia, including 1 systematic review and 34 RCTs.
The paper then discusses how many textbooks continue to recommend use of loop diuretics.

Repost of Nov 7 2010

About Amy

Clinical Informationist at EUH Branch Library
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