Hypercalcaemia Flashcards
What is the normal level of calcium?
2.1-2.6mmol/L
What is a mild increase in calcium?
Less than 3mmol/l
What is a moderate increase in calcium?
3-3.5mmol/l
What is a severe increase in calcium?
More than 3.5mmol/l
What is the rhyme for the symptoms of hypercalcaemia?
Stones, Bones, Moans, Groans
What does stones include?
Thirsty
Frequently passing urine
Dilute urine
(polyuria and polydipsia)
What does bones include?
Bone pain
Increased risk of fracture
What does groans include?
Abdominal pain
Nausea
Vomiting
Constipation
What are the main causes of hypercalcaemia?
Primary hyperparathyroidism
Malignancy
What does an increase in PTH cause?
An increase in calcium in the blood
How can malignancy cause hypercalcaemia?
Tumour secretes PTH related protein-
Squamous cell lung cancer
What are more unusual causes of hypercalcaemia?
Thiazide diuretics (increase ca from distal tubule) Excess vitamin D (increase ca from gut) Sarcoidosis (rare)
How is hypercalcaemia diagnosed?
Serum calcium levels
ECG
PTH (usually main investigation)
What would you see on an ECG with hypercalcaemia?
Decreased QT interval
Why would you test serum ACE?
For sarcoidosis
What is the management of hypercalcaemia?
0.9% IV saline
What is the management for weakened bones?
Bisphosphonates- Pamidronate
What is the management to correct fluid overload?
Diuretics- Furosemide
What is not necessary for the management of hypercalcaemia?
Low calcium diet
How does MEN 1 present?
Recurrent peptic ulcer
Galactorrhoea
Hypercalcaemia
What other endocrine conditions can cause hypercalcaemia?
Acromegaly
Addisons
What are the main causes of hypercalcaemia?
Primary hyperparathyroidism
Squamous cell lung cancer
Bone metastases
Myeloma
What medication can be given after rehydration with normal saline?
Bisphosphonates
When might you consider using loop diuretics such as furosemide?
Use in hypercalcaemia in patients who cannot tolerate aggressive fluid rehydration.
What does moans include?
Lethargy
Fatigue
Memory loss
Psychosis
Depression
An excess of which vitamin can cause hypercalcaemia?
Vitamin D
What is the main drug cause of hypercalcaemia?
Thiazide diuretics
