Management of Hypercalcemia in Heart Failure

Adjustment of Heart Failure Treatments

The American College of Cardiology recommends close monitoring of renal function and electrolytes, as hypercalcemia can worsen renal dysfunction 1, 2
If serum potassium exceeds 5.5 mmol/L during treatment with mineralocorticoid receptor antagonists (ARM), reduce the dose by half 3
If serum potassium exceeds 6.0 mmol/L or serum creatinine exceeds 310 μmol/L (3.5 mg/dL), stop ARM immediately 4
The European Society of Cardiology recommends adjusting the dose of diuretics according to the patient's volume status 4
Diuretics should be used with caution, as they can exacerbate electrolyte imbalances 1
The American Heart Association recommends avoiding calcium channel blockers in patients with heart failure with reduced ejection fraction (HFrEF), as they can have a negative inotropic effect 2

The European Journal of Heart Failure recommends frequent monitoring of serum calcium, renal function, and electrolytes 3, 4
For patients on ARM, check blood biochemistry at 1 and 4 weeks after starting/increasing the dose, then at 8 and 12 weeks, 6, 9, and 12 months, and every 4 months thereafter 4

The American College of Cardiology recommends not stopping beneficial SRAA inhibitors prematurely due to mild hyperkalemia 3
Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in patients with heart failure, as they can cause fluid retention and attenuate the effects of diuretics 2, 5
Even potassium levels in the upper limit of normal (4.8-5.0 mmol/L) have been associated with a higher risk of mortality 3
Thiazolidinediones increase the incidence of heart failure events and should be avoided 2