We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
1.1 Patients with cancer most at risk of hypercalcaemia are those with known bone metastases or myeloma. 20% do not have bone metastases.
1.2 Patients presenting with symptoms and/or signs suggestive of hypercalcaemia should have serum calcium and albumin checked. Symptoms include polydipsia, polyuria, confusion, constipation, anorexia.
1.3 The decision to treat is based on the corrected serum calcium level:
Corrected serum calcium = actual serum calcium+{(40- serum albumin g/L) x 0.02}
2.1 Step 1
Adequate hydration to correct dehydration.
3L over 24 hours 0.9% NaCl based on patient’s cardiac status.
2.2 Step 2
If glomerular filtration rate (GFR) > 30ml/min and still hypercalcaemic after adequate hydration, give IV zoledronate 4mg over 15 minutes in 100ml 0.9% sodium chloride (no dose adjustment if GFR > 30)
2.3 Step 3
If GFR < 30ml/min after hydration, discuss with consultant and give pamidronate if benefit outweighs risk (see note 3.4 below)
3.1 Review medication affecting renal function (e.g. NSAIDs, diuretics, ACE-inhibitors) and consider stopping or withholding.
3.2 Check U+E in 3-4 days (note that it can take up to 7 days for the full effects of bisphosphonate therapy to manifest). If corrected serum calcium has not returned to reference range, discuss future management with the consultant.
3.3 If consultant recommends rescue therapy, administer zoledronate 8mg over 60 minutes.
3.4 When using pamidronate in renal impairment:
3.4.1 Adjust dose according to the level of the corrected calcium as follows:
Calcium <3.0: 30mg
Calcium 3-3.5: 60mg
Calcium >3.5: 90mg
3.4.2 If GFR <30ml/min then administer pamidronate at a rate of 20mg/hour (in at least 500ml 0.9% sodium chloride. Volume will depend on renal function)
3.5 Please also refer to ‘Bisphosphonates in Myeloma’ on the haematology intranet site for further information on the use of bisphosphonates in myeloma.
3.6 Certain patients may require long-term bisphosphonate therapy to prevent recurrence of hypercalcaemia – discuss with consultant if this is unclear.
Acute Oncology Guidelines