严重高钙血症治疗攻略,速看!

2021-09-13 从医路漫漫 MedSci原创

高钙血症严重程度不同,处理方法也不同

    高钙血症严重程度不同,处理方法也不同(见下表)。轻度高钙血症(<3mmol/L,12mg/d)可通过补液纠正。极严重的高钙血症(3.2-3.7mmol/L,13-15mg/dl)必须积极处理,如果血钙高于以上水平,可危及生命,需要采取紧急措施干预。严重高钙血症多采用联合治疗,大多数患者血钙可在24~48h内降低0.7~2.2 mmol/I(3~mg/d),足以缓解急性症状,脱离高钙危象的致死风险,以便进一步对病因诊断进行评估。之后可针对原发病进行治疗。、

   高钙血症的发展与以下因素有关:骨钙的过度释放,肠道对钙吸收增加,或肾脏对钙清除率不足。了解病因有助于指导下一步治疗。例如恶性肿患者的高钙血症主要由于骨骼释放过多的钙所致,因此,限制饮食中的钙对改善高钙血症症状效果微乎其微。但是维生素D超敏感或维生素D中毒患者伴有肠钙吸收过多,因此限制饮食中的钙摄入量有助于治疗。肾功能下降或细胞外液缺乏可使尿钙排泄减少,这时应迅速水化可减轻或逆转高钙血症,即使此时骨吸收增加仍持续存在。如前所述,高钙血症症状越重,所需的联合治疗越多。快速起效(数小时内)的方法包括水化、强力利尿和给予降钙素,后者也可以和最有效的抗骨吸收剂如双膦酸盐类药物联合使用(因为严重高钙血症通常伴有过量骨吸收)。

治疗 起效时间 持续时间 优点 缺点
常规治疗方法
生理盐水补液 数小时 补液过程中 持续补液 容量负荷
利尿,生理盐水联合袢利尿剂 数小时 治疗期间 快速起效 容量负荷,心脏失代偿,密切监测,电解质紊乱,不方便
帕米磷酸盐 1-2天 10-14天至数周 高效,起效晚 20%发热,低磷血症,低钙血症,较少见颌骨坏死
唑来膦酸盐 1-2天 >3周 和帕米磷酸盐一样(作用时间更长) 同上
降钙素 数小时 1-2天 起效快,在严重高钙血症时起过渡治疗 快速耐受
特殊治疗方法
口服磷酸 24h 使用过程中 慢性治疗(伴有低磷血症)。若血磷浓度<4mg/dl毒性低 辅助治疗或慢性治疗外作用有限
糖皮质激素 数天 数天至数周 口服治疗,抗肿瘤治疗 仅对某些恶性肿瘤患者起效,糖皮质激素副作用
透析 数小时 使用过程中及透析后24-48h 肾衰患者获益,数小时起效,直接逆转危及生命的高钙血症 程序复杂,要求特殊环境

原文出处

Dennis L.Kasper,Anthony S.Fauci,Stephen L.Hauser,et al,HARRISON'S PRINCIPLES OF INTERNAL MEDICINE,19th Edition(308-309).

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    2021-09-15 小小的丁香花

    骨钙的过度释放,肠道对钙吸收增加,或肾脏对钙清除率不足。

    0

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    2021-09-14 小小的丁香花

    高钙血症的原因值得我们学习深挖

    0

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    2021-09-13 ms3000001348835381

    学习

    0

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