Immobilization Hypercalemia

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  1. 1. Immobilization Hypercalcemia Andrew N. Antonio, OTS University of St. Augustine
  2. 2. Overview Definition Etiology and pathophysiology Characterize the condition as it relates SCI Prosed Management Case Review Questions
  3. 3. Hypercalcemia Hypercalemia results when the accelerated bone resorption exceeds the capacity of the kidneys to filter calcium. Massagli & Cardenas, 1999
  4. 4. Calcium Regulation and processes of body functions Regulation Parathyroid hormone (PTH) Vitamin D Calcitonin
  5. 5. Hypercalcemia Mild (Ca+ 14 mg/dl) Diagnosed via blood test
  6. 6. Etiology Main cause is hyperparathyroidism (>90%) Common in women over 50 y/o Malignancies may be associated (20%) Inherited kidney or metabolic conditions Excessive Vitamin D & A Aluminum intoxication Milk-Alkali Syndrome
  7. 7. Immobilization Hypercalcemia Acute spinal cord injury (10-23%) Often in male adolescents/ young adults Tetraplegia v. paraplegia Increase bone resorption Loss of trabecular bone volume Decreased osteoblastic bone formation Depressed parathyroid hormone
  8. 8. Immobilization Hypercalcemia cont. Develops within days to months of immobilization ~4 - 8 weeks after Last weeks to months Hypercalciuria Within 1st week up to 6-18 months
  9. 9. Signs and Symptoms Fatigue Constipation Anorexia Nausea Alteration in mood Vomiting Lethargy Polydipsia Polyuria Intravascular volume depletion Hypertension Arrythmias
  10. 10. Treatment Goal: Decrease serum Ca+ concentration Underlying disease Hydration Loop Diuretics (i.e. furosemide) Biphosphonates Antineoplastic Drugs Antidote, hypercalcemia agents Glucocorticoids Minerals Calcimimetic Agent Surgical treatment Massagli & Cardenas, 1999
  11. 11. Zoledronic Acid Biphosphonate Ca+ Regulator Reduces risk for Fx Once-yearly injection 100-850 times more potent than Pamidronate Pagets 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
  12. 12. Rehabilitation Team Moans, Stones, Groans & Bones Early Remobilization Active movement Weight bearing Update on medical status Increase fluid intake Patient/ family/ caregiver education Massagli & Cardenas, 1999
  13. 13. 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
  14. 14. 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 Disodium Effectiveness, duration of Tx, and ease of administration appear promising Less interruption of activities Excellent response, with few complications Of 78% of the pts., only one treatment needed
  15. 15. Summary Acute SCI Difficult to detect early More in male adolescents and younger adults Varying levels of severity Cannot be prevented Aim to restore Ca+ levels, and treat underlying disease Mobilization and weight bearing Medications or injection
  16. 16. References Agrharkar, M. (2014). Hypercalcemia Medication. Retrieved December 5, 2014, from 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:// 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 Zoldronic Acid (Injection). (2014). Retrieved December 16, 2014, from
  17. 17. Questions ?