Abstract Comparative effectiveness of six to eight hour infusions of phosphate, sulfate, and hydrocortisone was studied in 22 hypercalcemic patients with neoplastic disease. Mean maximum reduction in serum calcium level with phosphate was dose dependent: 25 millimols, 1.1 mg/100 ml; 50 millimols, 2.44 mg/100 ml; 75 millimols, 4.13 mg/ 100 ml; and 100 millimols, 6.08 mg/100 ml. The reduction was also directly related to the rise in serum phosphate level. Sulfate infusion (38.9 gm) caused an average maximum decrease of serum calcium of 1.87 mg/100 ml. Hydrocortisone (200 mg) produced minor inconsistent changes in serum calcium and phosphate levels. Infusions of phosphate caused reduction in urinary calcium and rise in phosphate level. Both sulfate and hydrocortisone infusions resulted in rises in urinary calcium and urinary phosphate. These studies demonstrate the superiority of phosphate in treatment of hypercalcemia and suggest guidelines for dose selection. References 1. Muggia FM, Heinemann HO: Hypercalcemia associated with neoplastic disease. Ann Intern Med 73:281-290, 1970.Crossref 2. Myers WPL: Cortisone in the treatment of hypercalcemia in neoplastic disease. Cancer 11:83-88, 1958.Crossref 3. Watson L: A study of hypercalcemia in cancer. Quart J Med 33:525, 1964. 4. Goldsmith RS, Ingbar SH: Inorganic phosphate treatment of hypercalcemia of diverse etiologies. New Eng J Med 274:1-7, 1966.Crossref 5. Goldsmith RS, Bartos H, Hulley SB, et al: Phosphate supplementation as an adjunct in the therapy of multiple myeloma. Arch Intern Med 122:128-133,1968.Crossref 6. Chakmakjian ZH, Bethune JE: Sodium sulfate treatment of hypercalcemia. New Eng J Med 275:862-869, 1966.Crossref 7. Kahil M, Orman B, Gyorkey F, et al: Hypercalcemia, experience with phosphate and sulfate therapy. JAMA 201:721-724, 1967.Crossref 8. Thalassinos N, Joplin GF: Phosphate treatment of hypercalcemia due to carcinoma. Brit Med J 4:14-19, 1968.Crossref 9. Massry SG, Mueller E, Silverman AG, et al: Inorganic phosphate treatment of hypercalcemia. Arch Intern Med 121:307-312, 1968.Crossref 10. Hebert LA, Lemann J Jr, Peterson JR, et al: Studies of the mechanism by which phosphate infusion lowers serum calcium concentration. J Clin Invest 45:1886-1894, 1966.Crossref 11. Lemann J Jr, Mehr MP: Sodium sulfate infusions and hypercalcemia. JAMA 194:1126-1127, 1965.Crossref 12. Fiske CH, Subbarow YT: The colorimetric determination of phosphorus. J Biol Chem 66:375-400,1925. 13. Dudley HR, Ritchie AC, Schilling A, et al: Pathologic changes associated with the use of sodium ethylene diamine tetra-acetate in the treatment of hypercalcemia. New Eng J Med 252:331-337, 1955.Crossref 14. Walser M, Browder AA: Ion association: III. The effect of sulfate infusion on calcium excretion. J Clin Invest 38:1404-1411, 1959.Crossref 15. Heckman BA, Walsh JH: Hypernatremia complicating sodium sulfate therapy for hypercalcemic crisis. New Eng J Med 276:1082-1083, 1967.Crossref 16. Bulger HA, Dixon HH, Barr DP, et al: The functional pathology of hyperparathyroidism. J Clin Invest 9:143-190, 1930.Crossref 17. Dent CE: Some problems of hyperparathyroidism. Brit Med J 2:1495-1500, 1962.Crossref 18. Craig JM: Observations on the kidney after phosphate loading in the rat. Arch Path 68:306-315, 1959. 19. Breuer RI, LeBauer J: Caution in the use of phosphate in the treatment of severe hypercalcemia. J Clin Endocr 27:695-698, 1967.Crossref 20. Carey RW, Schmitt GW, Kopald HH, et al: Massive extraskeletal calcification during phosphate treatment of hypercalcemia. Arch Intern Med 122:150-155, 1968.Crossref 21. Albright F, Bauer W, Claflin D, et al: Studies in parathyroid physiology: III. The effect of phosphate ingestion in clinical hyperparathyroidism. J Clin Invest 11:411-435, 1932.Crossref 22. Bernstein DS, Newton R: The effect of oral sodium phosphate on the formation of renal calculi and on idiopathic hypercalcuria. Lancet 2:1105-1107, 1966.Crossref 23. Nagant de Deuxchaisnes C, Krane SM: The treatment of adult phosphate diabetes and Fanconi syndrome with neutral sodium phosphate. Amer J Med 43:508-543, 1967.Crossref 24. Pechet MM, Bobadilla E, Carroll EL, et al: Regulation of bone resorption and formation: Influences of thyrocalcitonin, parathyroid hormone, neutral. phosphate and vitamin D. Amer J Med 43:696-710, 1967.Crossref 25. Eisenberg E: Effect of intravenous phosphate on serum strontium and calcium. New Eng J Med 282:889-892, 1970.Crossref 26. Raisz L, Niemann I: Effect of phosphate, calcium and magnesium on bone resorption and hormonal responses in tissue culture. Endocrinology 85:446-452, 1969.Crossref 27. Dimich AB, Rothschild EO, Fulmer DH, et al: The action of phosphates in hypercalcemic states. Clin Res 17:588, 1969.
Archives of Internal Medicine – American Medical Association
Published: Jun 1, 1972