[24] Hypercalcaemia Flashcards

1
Q

What is the most common metabolic disorder associated with malignancy?

A

Hypercalcaemia

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2
Q

What proportion of cancer patients are affected by hypercalcaemia at some point in their disease course?

A

1/3

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3
Q

What malignancies are most commonly associated with hypercalcaemia?

A
  • Lung
  • Breast
  • Renal
  • Multiple myeloma
  • Adult T-cell lymphoma
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4
Q

What is the relevance of hypercalcaemia on prognosis?

A

It is a poor prognostic indicator in malignant disease, and may indicate uncontrolled tumour progress and metastasis

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5
Q

What is the 30-day mortality rate for cancer patients admitted to hospital with hypercalcaemia?

A

Almost 50%

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6
Q

What might the symptoms of hypercalcaemia mimic?

A

The features of terminal malignancy

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7
Q

What is the result of the symptoms of hypercalcaemia mimicing the features of terminal malignancy?

A

It can be difficult to identify

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8
Q

What is the problem with the symptoms of hypercalcaemia being difficult to identify?

A

Delayed recognition can worsen morbidity and mortality

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9
Q

What are some presenting features of hypercalcaemia?

A
  • Nausea and vomiting
  • Anorexia
  • Thirst and polydipsia
  • Polyuria
  • Lethargy
  • Bone pain
  • Abdominal pain
  • Constipation
  • Confusion
  • Weakness
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10
Q

At what level does hypercalcaemia become symptomatic?

A

There is no absolute level of calcium at which patients become symptomatic

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11
Q

What is usually more significant than the absolute level of calcium, with respect to the development of symptoms in hypercalcaemia?

A

The rate of increase

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12
Q

What investigations are done in hypercalcaemia?

A
  • Ionised calcium
  • Alkaline phosphatase
  • Renal function and electrolytes
  • X-rays
  • Bone scan
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13
Q

What is the most reliable laboratory test for hypercalcaemia?

A

Ionised calcium

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14
Q

What must be done if total calcium is used to measure hypercalcaemia?

A

Must calculate the corrected calcium level to allow for hypoalbuminaemia

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15
Q

What might x-rays show in hypercalcaemia?

A

Lytic or sclerotic lesions of bone

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16
Q

What is the purpose of bone scans in hypercalcaemia?

A

Identify any metastasis

17
Q

What does the management of hypercalcaemia involve?

A
  • Intensive rehydration

- IV bisphosphonates

18
Q

Give an example of a bisphosphonate

A

Pamidronate

19
Q

What should be considered when managing hypercalcaemia?

A

If it is appropriate to treat hypercalcaemia

20
Q

When may it not be appropriate to treat hypercalcaemia?

A

If the patient is receiving care for the last few days of life

21
Q

Is there palliative benefit in treating hypercalcaemia?

A

There may be palliative benefit from improving the symptoms of hypercalcaemia, even in patients with advanced malignancies