Hypercalcaemia

Question 1

Clinical Presentation of Hypercalcaemia (4).

Answer 1

1. Painful Bones, Renal Stones, Abdominal Groans and Psychic Moans, Thrones (Constipation or Frequent Urination) and Tones (Muscle Weakness and Hyporeflexia).
2. Corneal Calcification.
3. Hypotension.
4. Shortened QT Interval on ECG.

Question 2

Aetiology (Main) of Hypercalcaemia (2).

Answer 2

1. Primary Hyperparathyroidism.

2. Malignancy.

Question 3

Give 3 causes of malignancy-related Hypercalcaemia.

Answer 3

1. PTHrP from Tumour e.g. SCLC.
2. Bony Metastases.
3. Myeloma (Increased Osteoclastic Bone Resorption - Local Cytokines released by Myeloma Cells).

Question 4

Give 9 other causes of hypercalcaemia.

Answer 4

1. Sarcoidosis and Other Granulomatous Diseases e.g. TB, Histoplasmosis.
2. Vitamin D Intoxication.
3. Acromegaly.
4. Thyrotoxicosis.
5. Milk-Alkali Syndrome.
6. Drugs.
7. Dehydration.
8. Addison’s disease.
9. Paget’s disease of Bone (with prolonged immobilisation).

Question 5

Management of hypercalcaemia.

Answer 5

1. Rehydration with Normal Saline 3-4L/day.
2. Bisphosphonates (takes 2-3 days to work).
3. Other : Calcitonin (faster than Bisphosphonates) & Steroids in Bisphosphonates.

Question 6

When are loop diuretics preferred in hypercalcaemia?

Answer 6

Patients who cannot tolerate aggressive fluid rehydration.

Question 7

What is Hypercalcaemia?

Answer 7

Corrected Calcium > 2.65 mmol/L.