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
  1. Bone Malignancy
    • breast, lung, thyroid, kidney, prostate, myeloma, leukaemia
    • lymphoma, Hodgkin’s and non-Hodgkin’s
    • Paget’s (non-malignant increased bone turnover)
  2. Hyperparathyroidism
    • Normally responds to decreased Ca and increases bone turnover
  3. Other
    • endocrine (Addison’s, phaeochromocytoma, hyperthyroidism)
    • dehydration
    • respiratory (Sarcoidosis, TB)
    • drugs (lithium, thiazides, Vitamin D)
  4. 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)


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


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 700 6

Critical Care


Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM 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 |

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