Condition

4. Vital signs: q4h. Call physician if BP >160/90, <90/60; P >120, <50; R>25, <10; T >38.5°C; or tetany or any abnormal mental status.

5. Activity: Encourage ambulation; up in chair at other times.

6. Nursing: Seizure precautions, weigh patient bid, measure inputs and outputs.

7. Diet: Restrict dietary calcium to 400 mg/d, push PO fluids.

8. Special Medications:

-1-2 L of 0.9% saline over 1-4 hours until no longer hypotensive, then saline diuresis with 0.9% saline infused at 125 cc/h AND -Furosemide (Lasix) 20-80 mg IV q4-12h. Maintain urine output of 200 mL/h;

monitor serum sodium, potassium, magnesium -Calcitonin (Calcimar) 4-8 IV kg IM q12h or SQ q6-12h. -Etidronate (Didronel) 7.5 mg/kg/day in 250 mL of normal saline IV infusion over 2 hours for 3 days. -Pamidronate (Aredia) 60 mg in 1 liter of NS infused over 4 hours or 90 mg in 1 liter of NS infused over 24 hours x one dose.

9. Extras: CXR, ECG, mammogram.

10. Labs: Total and ionized calcium, SMA 7&12, phosphate, Mg, alkaline phosphatase, prostate specific antigen. 24h urine calcium, phosphate, parathyroid hormone.

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