Hypercalcaemia

Last updated 10.12.13

 

Definition

-  Serum Calcium > 10.4 mg/dL

- Must be corrected to albumin

 

Causes

-  Malignancy

-  Paraneoplastic: MM, Breast, Lung

-  1o Hyperparathyroidism

-  Other (less common)

-  Granulomatous: sarcoidosis, TB, leprosy, histoplasmosis

-  Medication

 

Associated S/S

-  Nausea, vomiting, constipation

-  Delerium, depression

-  Lethargy, Headache

-  Polyuria

-  Weakness, joint ache

-  Hyperreflexia, tongue fasciculations

-  HTN, bradycardia

 

Features

-  PTH: Bones, Groans, Stones & Psychic moans

-  Mild elevation usually asymptomatic (< 14mg/dL)

 

Ix

-  ECG

-  Short QT, long PR interval

-  Wide QRS, flat/inverted T wave, heart block

-  PTH

-  Normal: 1o hyperparathyroidism

-  PTHrP (Parathyroid Hormone related Peptide): malignancy

-  Calcitriol: granulomatous disease

-  CMP

-  Raised PO4: Vitamin D, thyrotoxicosis

 

Mx

-  Underlying cause

-  Stop meds (causing Hypercalcaemia)

-  IV fluids

-  Bisphosphanates: pamidronate, zoledronic acid

-  Frusemide (avoid thiazides)

-  Calcitonin