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Run npx skillmds@latest add dromlakhani/es-hcm-treat-bp-or-dmab in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Who published Es Hcm Treat Bp Or Dmab?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Es Hcm Treat Bp Or Dmab by dromlakhani

Name: Es Hcm Treat Bp Or Dmab
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Hcm Treat Bp Or Dmab

Recommends initiating intravenous bisphosphonate or denosumab for adults with hypercalcemia of malignancy compared with no treatment. Use when a clinician asks about first‑line pharmacologic therapy for HCM or when deciding to start antiresorptive agents.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Treat hypercalcemia of malignancy with IV bisphosphonate or denosumab

STEP 1 — Gather Information

Confirm adult patient with malignancy-associated hypercalcemia: symptoms (fatigue, nausea, polyuria, etc.), serum calcium above upper limit of normal, underlying malignancy documented. Collect serum calcium (adjusted for albumin or ionized calcium), renal function (eGFR), malignancy type, and prior antiresorptive exposure.

STEP 2 — Rule In / Rule Out

If hypercalcemia is attributable to malignancy (HCM) and not to primary hyperparathyroidism, vitamin D excess, or other non‑malignant causes, proceed to treatment; otherwise, pursue alternative diagnosis and do not initiate antiresorptive therapy for HCM.

STEP 3 — Classify or Stratify

Assess renal function to guide agent selection: if eGFR <30 mL/min/1.73 m², prefer denosumab; if eGFR ≥30 mL/min/1.73 m², either intravenous bisphosphonate (pamidronate or zoledronic acid) or denosumab may be used.

STEP 4 — Decide

Administer intravenous bisphosphonate (pamidronate 60–90 mg IV over 2–24 hours or zoledronic acid 4 mg IV over 15 minutes) or denosumab 120 mg subcutaneously, based on renal function and drug availability.

Clinical Guardrails / Mimics / Pitfalls

Do not use in patients without malignancy‑associated hypercalcemia; avoid in severe uncorrected hypocalcemia; monitor serum calcium and renal function after infusion; avoid rapid calcium correction that may precipitate arrhythmias; do not rely solely on antiresorptives in severe HCM without considering adjunct calcitonin for immediate calcium reduction; avoid in patients with known hypersensitivity to bisphosphonates or denosumab.

Concrete Clinical Example

A 62‑year‑old woman with metastatic breast cancer presents with fatigue and nausea; serum calcium 13.8 mg/dL (albumin 4.0 g/dL). Malignancy confirmed, eGFR 45 mL/min/1.73 m², no prior bisphosphonate. Initiate zoledronic acid 4 mg IV over 15 minutes.

Source: Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, DOI: 10.1210/clinem/dgac621

---name: es-hcm-treat-bp-or-dmabdescription: Recommends initiating intravenous bisphosphonate or denosumab for adults with hypercalcemia of malignancy compared with no treatment. Use when a clinician asks about first‑line pharmacologic therapy for HCM or when deciding to start antiresorptive agents.---# Treat hypercalcemia of malignancy with IV bisphosphonate or denosumab## STEP 1 — Gather InformationConfirm adult patient with malignancy-associated hypercalcemia: symptoms (fatigue, nausea, polyuria, etc.), serum calcium above upper limit of normal, underlying malignancy documented. Collect serum calcium (adjusted for albumin or ionized calcium), renal function (eGFR), malignancy type, and prior antiresorptive exposure.## STEP 2 — Rule In / Rule OutIf hypercalcemia is attributable to malignancy (HCM) and not to primary hyperparathyroidism, vitamin D excess, or other non‑malignant causes, proceed to treatment; otherwise, pursue alternative diagnosis and do not initiate antiresorptive therapy for HCM.## STEP 3 — Classify or StratifyAssess renal function to guide agent selection: if eGFR <30 mL/min/1.73 m², prefer denosumab; if eGFR ≥30 mL/min/1.73 m², either intravenous bisphosphonate (pamidronate or zoledronic acid) or denosumab may be used.## STEP 4 — DecideAdminister intravenous bisphosphonate (pamidronate 60–90 mg IV over 2–24 hours or zoledronic acid 4 mg IV over 15 minutes) or denosumab 120 mg subcutaneously, based on renal function and drug availability.## Clinical Guardrails / Mimics / PitfallsDo not use in patients without malignancy‑associated hypercalcemia; avoid in severe uncorrected hypocalcemia; monitor serum calcium and renal function after infusion; avoid rapid calcium correction that may precipitate arrhythmias; do not rely solely on antiresorptives in severe HCM without considering adjunct calcitonin for immediate calcium reduction; avoid in patients with known hypersensitivity to bisphosphonates or denosumab.## Concrete Clinical ExampleA 62‑year‑old woman with metastatic breast cancer presents with fatigue and nausea; serum calcium 13.8 mg/dL (albumin 4.0 g/dL). Malignancy confirmed, eGFR 45 mL/min/1.73 m², no prior bisphosphonate. Initiate zoledronic acid 4 mg IV over 15 minutes.**Source:** Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, DOI: 10.1210/clinem/dgac621

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