Download - Immobilization Hypercalemia
Immobilization HypercalcemiaAndrew N. Antonio, OTSUniversity of St. Augustine
OverviewDefinitionEtiology and pathophysiologyCharacterize the condition as it
relates SCIProsed ManagementCase ReviewQuestions
Hypercalcemia
“Hypercalemia results when the accelerated bone resorption exceeds the capacity of the kidneys to filter calcium.”
Massagli & Cardenas, 1999
CalciumRegulation and processes of body
functionsRegulation
◦Parathyroid hormone (PTH)◦Vitamin D◦Calcitonin
HypercalcemiaMild (Ca+ <12 mg/dl)Moderate (Ca+ between 12 and
14 mg/dl)Severe (Ca+ >14 mg/dl)
Diagnosed via blood test
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
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
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
Signs and SymptomsFatigueConstipationAnorexiaNauseaAlteration in moodVomitingLethargyPolydipsiaPolyuria Intravascular volume depletionHypertensionArrythmias
TreatmentGoal:
◦ Decrease serum Ca+ concentration◦ Underlying disease
HydrationLoop Diuretics (i.e. furosemide)BiphosphonatesAntineoplastic DrugsAntidote, hypercalcemia agentsGlucocorticoidsMineralsCalcimimetic AgentSurgical treatment
Massagli & Cardenas, 1999
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
Rehabilitation Team“Moans”, “Stones”, “Groans” &
“Bones”Early RemobilizationActive movementWeight bearingUpdate on medical statusIncrease fluid intakePatient/ family/ caregiver
education Massagli & Cardenas, 1999
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
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
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
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/
Questions?