2: Hyper- and HypoCalcaemia Flashcards
Define Hypercalcaemia
Calcium >2.62
What is the most common cause of hypercalcaemia in non-hospitalised patients
Primary hyperparathyroidism
What is the most common cause of hypercalcaemia in hospitalised patients
Malignancy
In determined the aetiology of hypercalcaemia what is first looked at
Albumin
If albumin is raised, what electrolyte is the looked at
Urea
if albumin raised, urea raised - what is the likely cause of hypercalcaemia
- Dehydration
if albumin raised, urea normal - what is the likely cause of hypercalcaemia
- Cuffed specimen
if albumin is normal/low what is then looked at
Phosphate
If phosphate is low what is suspected
- Hyperparathyroidism
If phosphate is high what marked is looked at
ALP
What may cause hypercalcaemia with raised ALP
- Bone mets
- Thyrotoxicosis
- Lithium
- Myeloma
- Vitamin D excess
What may cause hypercalcaemia and normal ALP
- Milk Alkali syndrome
- Sarcoidosis
How can milk-alkali syndrome be distinguished
Raised bicarbonate
What is mnemonic for symptoms in hypercalcaemia
Stones, Bones, Groans, Psychic Overtones
What investigations are ordered for hypercalcaemia
- Bone Profile (Calcium, Phosphate, PTH)
- Serum Magnesium
- ECG
What finding will be present on ECG in hypercalcaemia
Shortened QT Interval
If mild hypercalcaemia, how is it managed
Encourage Oral Fluid Intake
Reduce calcium in diet
at what calcium level do you treat
> 3.5 or symptomatic
what is first-line to lower high serum calcium
0.9% IV Saline
what medication is given for hypercalcaemia
Bisphosphates (Aledronic acid, Zoledronic acid)
what other management is offered for hypercalcaemia
Prednisolone - Sarcoidosis
Manage Malignancy
Parathyroidectomy - If Hyperparathyroidism
explain use of loop diuretics in hypercalcaemia
Loop diuretics can reduce calcium. However, they also cause dehydration which can precipitate high calcium. Therefore should only be used as a treatment when patient is fully rehydrated.
what serum calcium concentration defines hypocalcaemia
Less than 2.12
what should be ordered in low calcium
Phosphate
What are 5 causes of calcium with raised phosphate
- CKD
- Hypoparathyroidism
- Hypomagnesaemia
- Rhabdomyolysis (Acute)
- Psydohypoparathyroidism
What are 5 causes of hypocalcaemia with normal phosphate
- Vitamin D Deficeincy
- Osteomalacia
- Over-hydration
- Respiratory alkalosis
- Pancreatitis
How can osteomalacia be identified
Raised ALP
What can cause over-hydration
Massive blood transfusion
Explain respiratory alkalosis as a cause of hypocalcaemia
Respiratory alkalosis causes decrease in free ionised calcium and NOT total calcium.
This is because alkalosis increases ability of proteins (eg. albumin) to bind anions such as calcium
What is the mnemonic to remember symptoms of hypocalcaemia
SPASMODIC
What are the symptoms of hypocalcaemia
Spasms (Trousseaus, Chovstek)
Peri-oral parasthesia
Anxious, Irritable
Seizures
Muscle tone Increase
Orientation Impaired
Dermatitis
Impetigo herpetiformis
Coreoathetosis, cataracts, cardiomyopathy
What is impetigo herpetiformis
Hypocalcaemia and pustules in pregnancy
What investigations are ordered in hypocalcaemia
- Bone profile
- Magnesium
- ECG: prolong QT
What is given in acute hypocalcaemia
Calcium gluconate
If individual is not responding to calcium gluconate what is suspected
Low magnesium - supplement with magnesium
If hypocalcaemia due to CKD what is given
1a calcidol (vitamin D)
