Chapter 17: Fluids and Electrolytes- Hypercalcemia

Question 1

What are the causes?

Answer 1

CHIMPANZEES”:

• Calcium supplementation IV
• Hyperparathyroidism (1°/3°)/ hyperthyroidism
• Immobility/Iatrogenic (thiazide diuretics)
• Mets/Milk alkali syndrome
• Paget’s disease (bone)
• Addison’s disease/Acromegaly
• Neoplasm (colon, lung, breast, prostate, multiple myeloma)
• Zollinger–Ellison syndrome (as part of MEN I)
• Excessive vitamin D
• Excessive vitamin A
• Sarcoid

Question 2

What are the signs/symptoms?

Answer 2

Hypercalcemia—

• “Stones, bones, abdominal groans, and psychiatric overtones”
• Polydipsia, polyuria, constipation

Question 3

What are the ECG findings?

Answer 3

Short QT interval, prolonged PR interval

Question 4

What is the acute treatment of hypercalcemic crisis?

Answer 4

• Volume expansion with NS
• diuresis with furosemide (not thiazides)

Question 5

What are other options for lowering Ca+level?

Answer 5

• Steroids
• calcitonin
• bisphosphonates (pamidronate, etc.)
• mithramycin
• dialysis(last resort)