Hypercalcemia

Question 1

Presentation

Answer 1

GU - Polyuria, thirst, renal impairment
GI - Anorexia, nausea, constipation
Psych - Mood and cognitive changes
Neuro - confusion, coma
CV - short QT, arrythmias

Question 2

Causes

Answer 2

Most common - Malignancy, 1ary hyperPTH

Drug - Thiazides, Li, theophylline, VitDtoxicity
Endocrine - Thyrotoxicosis, phaeochromocytoma, adrenal insufficiency, 3ary hyperPTH
Granulomatous - sarcoid, TB
Familial hypocalciuric hypercalcemia
Iatrogenic - milk alkali syndrome

Question 3

Classification

• mild
• moderate
• severe

Answer 3

Mild - U3mmol/L
Moderate - 3-3.5
Severe - 3.5+

Question 4

Management

Answer 4

Rehydration - saline (4-6L in 24hrs)
-monitor for fluid overload in renal impairment/elderly => loop diuretics
IV bisphosphonates after 24hr rehydration

Daily bloods (U&E, Mg) until normal

Dialysis is an option for severely unwell

Question 5

Pathophysiology in malignancy

Answer 5

PTH/PTHrP => bone Ca release
Osteolysis from bone mets
High VitD => increased Ca GI uptake

Question 6

Management of refractory hypercalcemia

• corticosteroid
• calcitonin
• denosumab

Answer 6

CS - inhibits gut reabsorption, osteoclastic resorption

Calcitonin - reduce osteoclastic resorption, increased calciuresis

Denosumab - reduce osteoclast development