Hypercalcaemia Flashcards
(17 cards)
What is the initial step in confirming hypercalcaemia?
Measure serum calcium adjusted for albumin.
What symptoms should be assessed in a patient with hypercalcaemia?
Cognitive impairment, nausea, vomiting, dehydration, arrhythmias.
What initial investigations should be performed for hypercalcaemia?
PTH, phosphate, renal function, malignancy screening.
What ECG findings may indicate hypercalcaemia?
Shortened QT interval or conduction abnormalities.
What is the recommended initial management for dehydration in hypercalcaemia?
Intravenous rehydration with 0.9% sodium chloride.
How much intravenous fluid is typically administered for rehydration in hypercalcaemia?
2–4 liters over 24 hours.
What medications should be reviewed in the management of hypercalcaemia?
Thiazide diuretics, calcium or vitamin D supplements, lithium, NSAIDs, antacids.
What pharmacological treatment is given if corrected calcium remains ≥3.0 mmol/L after rehydration?
Intravenous bisphosphonates (zoledronic acid or pamidronate).
How long does it typically take for bisphosphonates to show effects in hypercalcaemia?
24–48 hours.
What is the dosing recommendation for bisphosphonates in hypercalcaemia?
Repeat dosing is generally not done within 48 hours.
What treatment may be considered for severe hypercalcaemia (>4.0 mmol/L)?
Subcutaneous calcitonin.
For what conditions might glucocorticoids be used in hypercalcaemia?
Vitamin D toxicity, granulomatous disease, haematological malignancy.
How often should serum calcium and renal function be monitored during treatment?
Daily.
What should be done if hypercalcaemia does not respond to bisphosphonates?
Seek specialist endocrinology or oncology advice.
What is the management for adjusted calcium levels of 2.6 – 3.0 mmol/L?
Oral/IV fluids, stop exacerbating meds, monitor.
What is the management for adjusted calcium levels ≥ 3.0 mmol/L?
Admit, IV fluids, bisphosphonates
What is the management for adjusted calcium levels > 4.0 mmol/L?
Urgent IV fluids, bisphosphonates, calcitonin, close monitoring.
