28.) Hypercalcemia Flashcards
(16 cards)
What is hypercalcemia?
Hypercalcemia is characterized by elevated levels of calcium in the blood, leading to symptoms such as fatigue, depression, mental confusion, anorexia, nausea, constipation, renal tubular defects, polyuria, short QT interval, and arrhythmias.
Normal ➡️ 2.2 – 2.6 mmol/L
What serum calcium level indicates CNS and GI symptoms?
Serum calcium >2.9 mmol/L indicates CNS and GI symptoms.
What serum calcium level indicates nephrocalcinosis and impairment of renal function?
Serum calcium >3.2 mmol/L indicates nephrocalcinosis and impairment of renal function.
What serum calcium level is considered severe hypercalcemia and a medical emergency?
Severe hypercalcemia is defined as serum calcium >3.7 mmol/L, which can lead to coma and cardiac arrest.
What is the etiology of primary hyperparathyroidism?
Primary hyperparathyroidism is caused by overactivity of the parathyroid glands, leading to excess production of parathyroid hormone (PTH), which increases calcium levels.
How can cancer cause hypercalcemia?
Cancer, particularly those that metastasize to the bones (e.g., breast cancer, lung cancer), can cause hypercalcemia through paraneoplastic syndromes that produce PTH-related protein (PTHrP).
What medications can lead to hypercalcemia?
Medications such as thiazide diuretics, lithium, and excessive vitamin D or calcium supplements can lead to hypercalcemia.
Which granulomatous diseases can increase calcium levels?
Granulomatous diseases like sarcoidosis or tuberculosis can increase vitamin D production, raising calcium levels.
What endocrine disorders are associated with hypercalcemia?
Endocrine disorders such as hyperthyroidism and adrenal insufficiency (Addison’s disease) are associated with hypercalcemia.
What are the clinical manifestations of hypercalcemia?
Clinical manifestations include nephrolithiasis, muscle pain, weakness, pancreatitis, peptic ulcer, gout, depression, fatigue, polydipsia, polyuria, hypertension, and weight loss.
What is the initial test for evaluating calcium imbalance?
The initial test for evaluating calcium imbalance is serum calcium concentration.
How can true hypocalcemia/hypercalcemia be confirmed?
True hypocalcemia/hypercalcemia can be confirmed by ordering an ionized calcium test or using serum albumin to calculate corrected calcium.
What indicates low PTH in malignancy?
Low PTH in malignancy is indicated by hypophosphatemia, hypercalciuria, high urine cAMP.
What is diagnostic of primary hyperparathyroidism?
A chloride/phosphorus ratio of >33 is diagnostic of primary hyperparathyroidism.
What is the treatment for mild or asymptomatic hypercalcemia?
Treatment includes encouraging adequate oral hydration, reducing dietary intake of calcium, and avoiding thiazide diuretics, lithium, and high-calcium diets.
What is the treatment for severe or symptomatic hypercalcemia?
Treatment includes IV hydration with isotonic saline, loop diuretics (furosemide 40mg), calcitonin (4IU/kg), and considering hemodialysis.
