# Es Hcm Dose Calcitonin

> Calculates salmon calcitonin dose based on patient weight for rapid calcium lowering in hypercalcemia of malignancy. Triggered when a clinician considers rapid calcium lowering and asks about weight‑based calcitonin dosing.

- Skill: `dromlakhani/es-hcm-dose-calcitonin` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/es-hcm-dose-calcitonin`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/es-hcm-dose-calcitonin/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: dromlakhani (https://skillmd.com/u/dromlakhani)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/dromlakhani/es-hcm-dose-calcitonin

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# Calculate salmon calcitonin dose based on patient weight

## STEP 1 — Gather Information
Obtain patient weight in kilograms and confirm clinical indication for rapid calcium lowering (e.g., serum calcium >14 mg/dL or symptomatic severe HCM). Record weight and proceed to dosing decision.

## STEP 2 — Rule In / Rule Out
Is the patient a candidate for calcitonin? Yes if severe HCM requiring rapid calcium lowering and planned to start an antiresorptive (bisphosphonate or denosumab); No if mild/moderate HCM or contraindication (e.g., known hypersensitivity). If No, use alternative agents; if Yes, continue to dose selection.

## STEP 3 — Classify or Stratify
Select a dose within the 4‑8 units/kg range based on clinical judgment (e.g., 6 units/kg as a typical starting point; consider lower end if renal impairment or frailty). Record the chosen units/kg.

## STEP 4 — Decide
Calculate dose per administration: weight (kg) × selected units/kg. Administer intramuscularly or subcutaneously every 6‑12 hours, not exceeding 48‑72 hours total due to tachyphylaxis.

## Clinical Guardrails / Mimics / Pitfalls
Do not extend calcitonin beyond 72 hours because tachyphylaxis diminishes effect; avoid using as monotherapy for long‑term HCM control; monitor serum calcium and watch for hypocalcemia, especially in renal insufficiency.

## Concrete Clinical Example
A 70‑kg patient with severe HCM (SCa 15.2 mg/dL) needs rapid lowering. Choose 6 units/kg → 420 units per dose. Give 420 units IM q8h for 48 hours, then reassess calcium and transition to bisphosphonate or denosumab.

**Source:** Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, https://doi.org/10.1210/clinem/dgac621

> **TODO:** consider adding scripts/calc.py for the es-hcm-dose-calcitonin calculator