Fast (4-h) or slow (24-h) infusions of pamidronate disodium (aminohydroxypropylidene diphosphonate (APD)) as single shot treatment of hypercalcaemia.
Twenty-five patients with hypercalcaemia (ionised calcium, 1.57 +/- 0.04 mM; total calcium, 3.33 +/- 0.06 mM) due to malignancy were randomised to receive pamidronate (1 mg/kg body wt.) by infusion over 4 h (12 patients) or 24 h (13 patients). Forced saline diuresis was not utilised. Two patients died within 24 h and were not included in the analysis. Both groups combined (n = 23) showed a decrease in ionised calcium to 1.44 +/- 0.04 mM by 2 days (P less than 0.05 vs. day 0). By 4 days there had been a further fall to 1.27 +/- 0.05 mM (P less than 0.05 vs. day 2) and 7 days after treatment ionised calcium was 1.19 +/- 0.05 mM (P less than 0.05 vs. day 4). Total calcium declined from 3.33 +/- 0.06 to 2.65 +/- 0.11 mM over 7 days (P less than 0.001). Separate analyses of the two groups showed that the fast (4-h) infusion led to an earlier reduction in calcium than did the 24-h infusion (P less than 0.02), although after 7 days there was little difference between the two groups (4 h, 1.18 +/- 0.09 mM; 24 h, 1.23 +/- 0.06 mM, n.s.). Hypercalcaemic symptoms (analogue rating scale) improved between each of the time intervals 0, 4 and 7 days (P less than 0.05) and did not differ between the two groups. We recommend a single 4-h infusion of pamidronate (1 mg/kg) as primary treatment for malignancy-induced hypercalcaemia.
Sawyer
N
N
Department of Nephrology, London Hospital, Whitechapel, England.
Newstead
C
C
Drummond
A
A
Cunningham
J
J
D002118:Calcium / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000652:urine; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D007700:Kinetics; D009369:Neoplasms / Q000150:complications*; D000077268:Pamidronate
D004164:Diphosphonates; D003404:Creatinine; D000077268:Pamidronate; D002118:Calcium