Schaiff R A, Hall T G, Bar R S
Department of Pharmacy, Barnes Hospital, St. Louis, MO 63110.
Clin Pharm. 1989 Feb;8(2):108-21.
Calcium homeostasis and the symptoms, etiology, and general medical management of hypercalcemia are reviewed. Hypercalcemia, an elevation in total serum calcium concentration, may produce neurologic, gastrointestinal, renal, and cardiovascular disturbances; it may also cause calcification in extraskeletal tissue. Hyperparathyroidism and malignancy cause more than 90% of cases of this potentially fatal disorder. When correction of the underlying cause of hypercalcemia is impossible, calcium-lowering therapy is necessary. Acute management of hypercalcemia often involves rehydration, mobilization of the patient, and furosemide-induced diuresis. These measures may be followed by intravenous administration of etidronate, plicamycin, or calcitonin. Agents used in the long-term management of hypercalcemia include oral phosphates, oral etidronate, intermittent intravenous plicamycin, and, in selected patients, corticosteroids and nonsteroidal anti-inflammatory agents. Investigational calcium-lowering agents include gallium nitrate, ethiofos, dichloromethylene diphosphonate, and aminohydroxyproline diphosphonate. Many agents are available for the treatment of hypercalcemia. Therapy can be individualized by integrating knowledge of the physiologic causes of hypercalcemia, the mechanism of action of calcium-lowering drugs, and the patient's other disease states. Further studies are needed to define the role of investigational calcium-lowering agents.
本文综述了钙稳态以及高钙血症的症状、病因和一般医学处理方法。高钙血症是指血清总钙浓度升高，可导致神经、胃肠、肾脏和心血管系统紊乱；还可能引起骨骼外组织钙化。甲状旁腺功能亢进和恶性肿瘤导致了这种潜在致命疾病90%以上的病例。当无法纠正高钙血症的根本原因时，降低血钙的治疗是必要的。高钙血症的急性处理通常包括补液、患者活动以及呋塞米诱导的利尿。这些措施之后可静脉注射依替膦酸二钠、普卡霉素或降钙素。用于高钙血症长期管理的药物包括口服磷酸盐、口服依替膦酸二钠、间歇性静脉注射普卡霉素，以及在特定患者中使用的皮质类固醇和非甾体抗炎药。正在研究的降钙药物包括硝酸镓、依替膦酸、二氯亚甲基二膦酸盐和氨基羟脯氨酸二膦酸盐。有许多药物可用于治疗高钙血症。通过整合高钙血症生理原因、降钙药物作用机制以及患者其他疾病状态的知识，可以实现个体化治疗。需要进一步研究来确定正在研究的降钙药物的作用。
