Unique Plan Description: Hypercalcemia
Plan Selection Display: Hypercalcemia
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-01-11 17:59:13
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:56:41
Available at all facilities: Yes

Hypercalcemia
Laboratory
Today's Lab
	Ionized Calcium
		Routine, spec type = Blood
	Magnesium Level
		Routine, spec type = Blood
	Phosphorus
		Routine, spec type = Blood
	Basic Metabolic Panel
		Routine, spec type = Blood
	Parathyroid Hormone
		Routine, spec type = Blood
	Parathyroid Hormone-Related Peptide LC-MS/MS
		Routine, spec type = Blood
	Vitamin D 25-Hydroxy Level (preferred for deficiency)
		Routine, spec type = Blood
	Vitamin D Level (renal/hypercalcemia)
		Routine, spec type = Blood
	TSH
		Routine, spec type = Blood
	Albumin
		Routine, spec type = Blood
	Cortisol Level
		Routine, spec type = Blood
	Vitamin A Level
		Routine, spec type = Blood
	Protein Electrophoresis Serum
		Routine, spec type = Blood
	Bence Jones Urine (Immunofixation).
		Routine, Routine, spec type = Urine
Diagnostic Tests
Radiology
	Chest 1 View
		Routine, Cancer
IV Solutions

	Sodium Chloride 0.9%
		1,000 mL, IV, 1 Dose(s)/Time(s), Bolus
			Comment: for treatment of symptomatic or severe (>14mg/dL) hypercalcemia
		1,000 mL, IV, 200 ml/hr
			Comment: for treatment of symptomatic or severe (>14mg/dL) hypercalcemia
Medications
	Lasix Injection
		40 mg, IV PUSH, Once
			Comment: for treatment of symptomatic or severe (>14mg/dL) hypercalcemia
		80 mg, IV PUSH, Once
			Comment: for treatment of symptomatic or severe (>14mg/dL) hypercalcemia
		After failure of IVF and Lasix, may choose 1 of below (effective in 2+ days):(NOTE)*
	Aredia IVPB
		60 mg, Injection, IVPB, Once
			Comment: Pharmacy to adjust for renal function. For Albumin-corrected serum calcium 12-13.5 mg/dL
		90 mg, Injection, IVPB, Once
			Comment: Pharmacy to adjust for renal function. for Albumin-corrected serum calcium >=13.5 mg/dL
	zoledronic acid
		4 mg, Injection-Premix, IVPB, Once, T;N, Infuse Over 15 min(s)
			Comment: Preferred for hypercalcemia of malignancy. Pharmacy to adjust for renal function.
		For effect within 6-12 hours:(NOTE)*
	Miacalcin
		4 IU/kg, Injection, SUBCUTANEOUS, Once, NOW
		Discontinue all MVI, Calcium and Vitamin D(NOTE)*
Consults/Follow-up
	Pharmacy Consult
		Pharmacy to review meds for cause of hypercalcemia, especially (thiazides, lithium and theophylline). Verify all MVI, calcium, and Vitamin D have been discontinued.
	Consult Endocrinologist
		Reason for Referral: Hypercalcemia
	Consult Oncologist
		Reason for Referral: Hypercalcemia

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase