Hypercalcaemia Flashcards
What is the normal serum calcium concentration?
2.2mmol/L - 2.6mmol/L
What is hypercalcaemia?
It is defined as a serum calcium concentration greater than 2.6mmol/L
What are the three classifications of hypercalcaemia?
Mild Hypercalcaemia
Moderate Hypercalcaemia
Severe Hypercalcaemia
What is mild hypercalcaemia?
It is defined as serum calcium levels below 3mmol/L
What is moderate hypercalcaemia?
It is is defined as serum calcium levels between 3mmol/L - 3.5mmol/L
What is severe hypercalcaemia?
It is defined as serum calcium levels greater than 3.5mmol/L
What are the eight risk factors of hypercalcaemia?
Primary Hyperparathyroidism
Malignancy
Addison’s Disease
Acromegaly
Hyperthyroidism
Sarcoidosis
Paget’s Disease
Drug Administration
What is the most common cause of hypercalcaemia in community patients?
Primary Hyperparathyroidism
What is the most common cause of hypercalcaemia in hospitalised patients?
Malignancy
Which four malignancies are associated with hypercalcaemia?
Squamous cell lung cancer
Prostate cancer
Bone metastases
Myeloma
What two drugs are associated with hypercalcaemia?
Thiazide diuretics
Vitamin D supplements
What are the twelve clinical features of hypercalcaemia?
“Bones, stones, groans and psychic moans”
Fatigue
Bone Pain
Osteoporosis
Polyuria
Polydipsia
Renal Calculi
Abdominal Pain
Constipation
Corneal Calcification
Confusion
Low Mood
Hypertension
What are the two investigations used to diagnose hypercalcaemia?
Blood Tests
ECG Scan
What four blood test results indicate hypercalcaemia?
Increased Calcium Levels
Decreased Phosphate Levels
Normal/Increased PTH Levels
Increased ACE Levels
What is the first line investigation used to investigate hypercalcaemia?
Parathyroid hormone blood test
How are PTH levels used to investigate hypercalcaemia?
They enable identification of primary hyperparathyroidism - which is a common cause of hypercalcaemia
How are ACE levels used to investigate hypercalcaemia?
They enable identification of sarcoidosis - which is a common cause of hypercalcaemia
What are the two ECG scan features of hypercalcaemia?
Shortened QTc Interval
Bradycardia
What are the three pharmacological management options of hypercalcaemia?
IV Fluid Therapy
Bisphosphonates
Calcitonin
When is IV fluid therapy used to manage hypercalcaemia?
It is the first line management option
What IV fluid is used to manage hypercalcaemia?
0.9% saline
When are bisphosphonates used to manage hypercalcaemia?
They are the second line management option of hypercalcaemia, following rehydration with normal saline
What is the mechanism of action of bisphosphonates?
They inhibit bone resorption, preventing the release of calcium from bone stores
When is calcitonin used to manage hypercalcaemia?
It is the third line management option of hypercalcaemia, in cases where bisphosphonates are contraindicated
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
What is the surgical management option of hypercalcaemia?
Parathyroidectomy
When is parathyroidectomy used to manage hypercalcaemia?
It is considered in cases where hypercalcaemia is related to primary hyperparathyroidism
What is parathyroidectomy?
It involves removal of one of the parathyroid glands
What advice should be given to hypercalcaemia patients whilst awaiting endocrinology follow up?
Increased fluid intake
