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Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice
- Susan B. LeGrand, MD;
- Dona Leskuski, DO; and
- Ivan Zama, MD
- From the Harry R. Horvitz Center for Palliative Medicine (World Health Organization demonstration project) and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, and Capital Hospice and Capital Palliative Care Consultants, Falls Church, Virginia.
Abstract
Although primary hyperparathyroidism is the most common cause of hypercalcemia, cancer is the most common cause requiring inpatient intervention. An estimated 10% to 20% of all patients with cancer have hypercalcemia at some point in their disease trajectory, particularly in advanced disease. Aggressive saline hydration and varying doses of furosemide continue to be the standard of care for emergency management. However, a review of the evidence for the use of furosemide in the medical management of hypercalcemia yields only case reports published before the introduction of bisphosphonates, in contrast to multiple randomized, controlled trials supporting the use of bisphosphonates. The use of furosemide in the management of hypercalcemia should no longer be recommended.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Susan B. LeGrand, MD, Harry R. Horvitz Center for Palliative Medicine, Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, 9500 Euclid Avenue R35, Cleveland, OH 44195; e-mail, legrans{at}ccf.org.
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Current Author Addresses: Drs. LeGrand and Zama: Harry R. Horvitz Center for Palliative Medicine, Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, 9500 Euclid Avenue R35, Cleveland, OH 44195.
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Dr. Leskuski: 209 Gibson Street Northwest, Suite 202, Leesburg, VA 20176.
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