Acute hypercalcaemia

Question 1

What are the signs and symptoms of hypercalcaemia?

Answer 1

Bones (bone pain), stones (kidney/biliary), groans (abdominal pain, nausea and vomiting), thrones (polyuria –> dehydration) and psychic moans (depression, anxiety)

Abdo pain, constipation, polyuria, polydipsia, depression, anorexia, weight loss, tiredness, weakness, HTN, confusion, pyrexia, renal stones, renal failure, ectopic calcification, cardiac arrest
Reduced QT interval

Question 2

What are causes of hypercalcaemia?

Answer 2

Malignancy e.g. from bone mets, myeloma, PTHrP
Primary hyperparathyroidism.
Sarcoidosis
Vitamin D intoxication
Thyrotoxicosis
Lithium
Tertriary hyperparathryoidsm

Question 3

Why is there polydipsia in hypercalcaemia?

Answer 3

Nephrogenic diabetes inspires due to nephrocalcinosis
Results in dehydration
This leads to polydipsia

Question 4

Why high there be fatigue and confusion in hypercalcaemia?

Answer 4

The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor and / or coma. In the gut this causes constipation. Hypocalcaemia causes the opposite by the same mechanism.

Question 5

What investigations in hypercalcaemia?

Answer 5

Albumin
Phosphate
Urea
ALP
PTH
Potassium
Chloride
FBC
CXR - sarcoidosis/TB
Isotope bone scan

Question 6

What investigations suggest malignancy?

Answer 6

Low albumin, Raised ALP from increased bone turnover - bone metastases,
Raised phosphate - myeloma
Hypokalaemia

Question 7

What if albumin is raised and urea is raised?

Answer 7

Dehydration

Question 8

What is albumin normal and phosphate is low/normal and urea is normal

Answer 8

Primary or tertiary hyperparathyroidism

Question 9

How would you manage hypercalemia acutely?

Answer 9

Correct dehydration with 0.9% saline IV
Diagnose and treat underlying cause
Bisphosphonates - prevent bone resorption by inhibiting osteoclast activity. A sign dose lowers Ca of 2-3 days.
Infuse slowly via large vein.
SE: flu symptoms, low phosphate, bone pain, myalgia

Chemotherapy in malgincnay, steroids in sarcoidiosis

Question 10

What drugs lower Ca levels? MOA?

Answer 10

Bisphosphonates - prevent bone resorption by inhibiting osteoclast activity. A sign dose lowers Ca of 2-3 days.
Infuse slowly via large vein.
SE: flu symptoms, low phosphate, bone pain, myalgia