Hypercalcaemia DDx
Causes of HYPERcalcaemia
- Nature: Bones, stones, groans and psychic moans
- Usually associated with increased calcium release form bones and impaired renal removal and malignancy
- Causes: >90% from Malignancy and Hyperparathyroidism
- Basically: Tumour, increased PTH and increased Vitamin D
- Bone Malignancy
- breast, lung, thyroid, kidney, prostate, myeloma, leukaemia
- lymphoma, Hodgkin’s and non-Hodgkin’s
- Paget’s (non-malignant increased bone turnover)
- Hyperparathyroidism
- Normally responds to decreased Ca and increases bone turnover
- Other
- endocrine (Addison’s, phaeochromocytoma, hyperthyroidism)
- dehydration
- respiratory (Sarcoidosis, TB)
- drugs (lithium, thiazides, Vitamin D)
- Fictitious
- Not corrected level for albumin
- Prolonged cuff time
Clinical symptoms
- Stones (Renal colic and hypercalcaemic stones)
- Bones (Increased osteolysis and fractures)
- Psychic moans (Depression, confusion, hallucinations and coma)
- Abdominal groans (Anorexia, N, V, constipation, PUD, pancreatitis)
- Other
- Muscle weakness, malaise, hyporeflexia
- Confusion, apathy, decreased memory
- Nephrogenic diabetes insipidus (Polyuria and polydipsia)
Complication
Cardiac Arrhythmia and ECG changes
- QT shortening (Prolonged with low K, Ca, Mg)
- Prolonged PR
- Widened QRS
- Notched QRS with increased voltage
- AV block…..CHB…..cardiac arrest
Correction
Key to treatment is volume expansion
- Promote urinary excretion(if CVS and renal function adequate)
- Forced saline Diuresis (plus magnesium and potassium) – 300-500ml N saline/hr
- This replaces lost fluid and forces diuresis
- Must monitor or replace K and Mg as these will be lost in the urine along with the calcium
- NOTE do not give THIAZIDES, they will worsen condition
- Treatment with FRUSEMIDE is controversial as it promotes Calcium bone reuptake
- Haemodialysis
- Treatment of choice in CVS or renal compromise
- Calcitonin/EDTA bisphosphonates
- Reduce bone resorption and reduce GIT absorption of Calcium
- Effect in 48 hours and last 15 days
References and Links
- CCC – Calcium metabolism
- CCC – Calcium basics
- CCC – Hypercalcaemia Overview
- CCC – Hypocalcaemia
- CCC – Calcium replacement (advantages/disadvantages)
- CCC – Calcium as an inopressor
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Critical Care
Compendium
BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Associate Professor Curtin Medical School, Curtin University. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |