Ca

Question 1

What are the normal levels of calcium?

Answer 1

• Normal = 2.20 - 2.65 mmol/L
• Adjusted corrected (because calcium is bound to albumin)
  = 2.10 - 2.58 mmol/L

Question 2

Which patients may need calcium?

Answer 2

• Children
• Pregnancy
• Osteoporosis
• Elderly

Question 3

What are the risks of Hypercalcaemia?

Answer 3

• Renal damage
• Cardiac arrest (> 3.5 mmol/L)
• Effects of Digoxin is enhanced in hypercalcemia

Question 4

What are the causes of Hypercalcaemia?

Answer 4

1. Malignancy (with bone metastases
2. Thyrotoxicosis
3. Hyperparathyroidism (in the elderly)
4. Drugs

Question 5

Hypercalcaemia - symptoms

Answer 5

• Nausea
• Lethargy
• Muscle cramps
• Confusion
• Arrythmias

Question 6

Hypercalcaemia - drugs

Answer 6

1. Thiazide-diuretics
2. Vitamin D (Very high dose e.g. 50,000U a day)
3. Lithium
4. Tamoxifen

Question 7

Hypercalcaemia - treatment

Answer 7

1. Bisphosphonates
2. Calcitonin
3. Cinacalcet
4. Corticosteroids
5. Treat HYPERparathyroidism

Question 8

Severe hypercalcaemia - treatment

Answer 8

• IV NaCl 0.9%
• Discontinue drugs which cause hypercalcaemia
• Restrict dietary Ca

Question 9

Hypercalcaemia is due to sarcoidosis or vitamin D toxicity

Answer 9

CS

Question 10

Hypercalcaemia associated with malignancy

Answer 10

Calcitonin

Question 11

Hypocalcaemia - symptoms

Answer 11

• Muscle cramps
• Confusion/ depression
• Forgetful

Question 12

Hypocalcaemia - causes

Answer 12

1. Chronic Renal failure
2. HYPOparathyroidism
3. Drugs

Question 13

Hypocalcaemia - drugs

Answer 13

1. Bisphosphonates
2. Loop diuretics
3. Rifampicin, Phenytoin, Phenobarbital

Question 14

Hypocalcaemia - treatment

Answer 14

1. Calcium
   - Calcium carbonate
   - Calcium chloride
   AND
2. Vitamin D

Question 15

Severe acute hypocalcaemia or hypocalcaemic tetany

Answer 15

• Initial slow IV calcium gluconate 10% with plasma-calcium and ECG monitoring
• Repeated if needed or follow with continuous IV infusion to prevent recurrence