# 一名轉移性乳癌個案出現意識混亂、多尿、脫水，矯正後血鈣為14.6 mg/dL。護理師應預期哪些處置？請選擇所有適用者。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375025&lang=zh-tw  
> language: zh-TW  
> subject: Management of Care  
> category: MOC

## 題目

一名轉移性乳癌個案出現意識混亂、多尿、脫水，矯正後血鈣為14.6 mg/dL。護理師應預期哪些處置？請選擇所有適用者。

1

IV zoledronic acid於數日內持續降鈣

2

限水以減少鈣傳送至腎臟

3

等張食鹽水200-300 mL/小時積極輸液,目標尿量100-150 mL/小時

4

若腎不全無法使用bisphosphonate則考慮denosumab

5

皮下calcitonin於12-48小時內快速降鈣

## 解析

惡性腫瘤引起的嚴重高血鈣首先需要以等張生理食鹽水每小時200-300毫升進行體液擴張，目標尿量每小時100-150毫升，以促進鈣的尿液排出。降鈣素可快速但產生快速耐受性，在12-48小時內降低血鈣，作為雙磷酸鹽類藥物的橋接治療。唑來膦酸可持續數天降低血鈣，但由腎臟清除——若肌酸酐清除率低於30，則優先使用denosumab。限水會減少腎臟鈣的清除，惡化高血鈣。除非因補充體液而導致體液過載，否則不常規使用環利尿劑。

## 深入解析

結石、骨痛、腹部抱怨、精神不適。鈣14+須立即處置;18+為急症。

## 臨床情境

嗜睡、間歇定向。直立性低血壓。EKG QT縮短。

## 重要概念

- **惡性高血鈣** — 常為PTHrP介導 — 乳癌、肺癌、多發性骨髓瘤。
- **Zoledronic acid** — IV bisphosphonate抑制破骨細胞活性。
- **Denosumab** — 抗RANKL單株抗體 — 腎不全可安全使用。

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