Does Furosemide Have a Role in the Management of Hypercalcemia?
Authors: R. Brooks Robey
Journal: Annals of Internal Medicine (2009)

Letters20 January 2009Does Furosemide Have a Role in the Management of Hypercalcemia?R. Brooks Robey, MD, James P. Lash, MD, and Jose A.L. Arruda, MDR. Brooks Robey, MDFrom the Veterans Affairs Medical Center and Dartmouth Medical School, White River Junction, VT 05009, and University of Illinois at Chicago College of Medicine, Chicago, IL 60612., James P. Lash, MDFrom the Veterans Affairs Medical Center and Dartmouth Medical School, White River Junction, VT 05009, and University of Illinois at Chicago College of Medicine, Chicago, IL 60612., and Jose A.L. Arruda, MDFrom the Veterans Affairs Medical Center and Dartmouth Medical School, White River Junction, VT 05009, and University of Illinois at Chicago College of Medicine, Chicago, IL 60612.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-2-200901200-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:LeGrand and colleagues (1) concluded, on the basis of their recent review of the literature, that furosemide has no role in the modern management of hypercalcemia. We take issue with this contention and note the fundamental limitations of their analysis.Bisphosphonates attenuate bone calcium mobilization and address a major—but not the sole—clinical contributor to hypercalcemia. Hypercalcemia may also result from increased gastrointestinal calcium uptake. Decreased renal excretion alone does not cause hypercalcemia but does aggravate hypercalcemia from other causes. Volume contraction and dehydration due to natriuresis and nephrogenic diabetes insipidus, respectively, also amplify hypercalcemia of all causes. ...References1. LeGrand SB, Leskuski D, Zama I. Narrative review: furosemide for hypercalcemia: an unproven yet common practice. Ann Intern Med. 2008;149:259-63. [PMID: 18711156] LinkGoogle Scholar2. Suki WN, Yium JJ, Von Minden M, Saller-Hebert C, Eknoyan G, Martinez-Maldonado M. Actue treatment of hypercalcemia with furosemide. N Engl J Med. 1970;283:836-40. [PMID: 5458033] CrossrefMedlineGoogle Scholar3. Eknoyan G, Suki WN, Martinez-Maldonado M. Effect of diuretics on urinary excretion of phosphate, calcium, and magnesium in thyroparathyroidectomized dogs. J Lab Clin Med. 1970;76:257-66. [PMID: 5434005] MedlineGoogle Scholar4. Martinez-Maldonado M, Eknoyan G, Suki WN. Diuretics in nonedematous states. Physiological basis for the clinical use. Arch Intern Med. 1973;131:797-808. [PMID: 4576265] CrossrefMedlineGoogle Scholar5. Reyes AJ, Taylor SH. Diuretics in cardiovascular therapy: the new clinicopharmacological bases that matter. Cardiovasc Drugs Ther. 1999;13:371-98. [PMID: 10547218] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: R. Brooks Robey, MD; James P. Lash, MD; Jose A.L. Arruda, MDAffiliations: From the Veterans Affairs Medical Center and Dartmouth Medical School, White River Junction, VT 05009, and University of Illinois at Chicago College of Medicine, Chicago, IL 60612.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNarrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice Susan B. LeGrand , Dona Leskuski , and Ivan Zama Does Furosemide Have a Role in the Management of Hypercalcemia? Susan B. LeGrand Metrics Cited byManagement of severe hypercalcaemia secondary to primary hyperparathyroidism: The efficacy of saline hydration, furosemide, and zoledronic acidPsychiatric Emergencies for Clinicians: Emergency Department Management of HypercalcemiaMedications That Affect CalciumBenefits and risks of furosemide in acute kidney injuryUse of Furosemide for Milk-Alkali Syndrome–Reply–I 20 January 2009Volume 150, Issue 2Page: 146-147KeywordsBoneCalciumConflicts of interestExcretionHypercalcemiaSystematic reviews ePublished: 20 January 2009 Issue Published: 20 January 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...