Hypercalcaemia Flashcards

1
Q

What is the normal serum calcium concentration?

A

2.2mmol/L - 2.6mmol/L

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2
Q

What is hypercalcaemia?

A

It is defined as a serum calcium concentration greater than 2.6mmol/L

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3
Q

What are the three classifications of hypercalcaemia?

A

Mild Hypercalcaemia

Moderate Hypercalcaemia

Severe Hypercalcaemia

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4
Q

What is mild hypercalcaemia?

A

It is defined as serum calcium levels below 3mmol/L

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5
Q

What is moderate hypercalcaemia?

A

It is is defined as serum calcium levels between 3mmol/L - 3.5mmol/L

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6
Q

What is severe hypercalcaemia?

A

It is defined as serum calcium levels greater than 3.5mmol/L

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7
Q

What are the eight risk factors of hypercalcaemia?

A

Primary Hyperparathyroidism

Malignancy

Addison’s Disease

Acromegaly

Hyperthyroidism

Sarcoidosis

Paget’s Disease

Drug Administration

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8
Q

What is the most common cause of hypercalcaemia in community patients?

A

Primary Hyperparathyroidism

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9
Q

What is the most common cause of hypercalcaemia in hospitalised patients?

A

Malignancy

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10
Q

Which four malignancies are associated with hypercalcaemia?

A

Squamous cell lung cancer

Prostate cancer

Bone metastases

Myeloma

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11
Q

What two drugs are associated with hypercalcaemia?

A

Thiazide diuretics

Vitamin D supplements

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12
Q

What are the twelve clinical features of hypercalcaemia?

A

“Bones, stones, groans and psychic moans”

Fatigue

Bone Pain

Osteoporosis

Polyuria

Polydipsia

Renal Calculi

Abdominal Pain

Constipation

Corneal Calcification

Confusion

Low Mood

Hypertension

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13
Q

What are the two investigations used to diagnose hypercalcaemia?

A

Blood Tests

ECG Scan

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14
Q

What four blood test results indicate hypercalcaemia?

A

Increased Calcium Levels

Decreased Phosphate Levels

Normal/Increased PTH Levels

Increased ACE Levels

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15
Q

What is the first line investigation used to investigate hypercalcaemia?

A

Parathyroid hormone blood test

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16
Q

How are PTH levels used to investigate hypercalcaemia?

A

They enable identification of primary hyperparathyroidism - which is a common cause of hypercalcaemia

17
Q

How are ACE levels used to investigate hypercalcaemia?

A

They enable identification of sarcoidosis - which is a common cause of hypercalcaemia

18
Q

What are the two ECG scan features of hypercalcaemia?

A

Shortened QTc Interval

Bradycardia

19
Q

What are the three pharmacological management options of hypercalcaemia?

A

IV Fluid Therapy

Bisphosphonates

Calcitonin

20
Q

When is IV fluid therapy used to manage hypercalcaemia?

A

It is the first line management option

21
Q

What IV fluid is used to manage hypercalcaemia?

A

0.9% saline

22
Q

When are bisphosphonates used to manage hypercalcaemia?

A

They are the second line management option of hypercalcaemia, following rehydration with normal saline

23
Q

What is the mechanism of action of bisphosphonates?

A

They inhibit bone resorption, preventing the release of calcium from bone stores

24
Q

When is calcitonin used to manage hypercalcaemia?

A

It is the third line management option of hypercalcaemia, in cases where bisphosphonates are contraindicated

25
What is the mechanism of action of calcitonin?
It inhibits osteoclast cells, which therefore reduces bone breakdown and prevents the release of calcium from bone stores
26
What is the surgical management option of hypercalcaemia?
Parathyroidectomy
27
When is parathyroidectomy used to manage hypercalcaemia?
It is considered in cases where hypercalcaemia is related to primary hyperparathyroidism
28
What is parathyroidectomy?
It involves removal of one of the parathyroid glands
29
What advice should be given to hypercalcaemia patients whilst awaiting endocrinology follow up?
Increased fluid intake