Hypercalcaemia (2)

Question 1

What is it defined as?

What are its most common causes?

What are its other causes?

How does it present?

Answer 1

➊ Correct calcium > 2.65 mmol/L

➋ Primary Hyperparathyroidism, Malignancy

➌ • Thiazide diuretics
• Vit D intoxication
• Ca-containing drugs
• Sarcoidosis
• TB
• Familial Hypocalciuric Hypercalcaemia

➍ Stones, Bones, Groans and Psychiatric moans
• Kidney stones
• Painful bones
• Abdominal groans - N+V, Constipation, Indigestion
• Psychiatric moans - Depression, Fatigue, Memory loss, Psychosis

Question 2

What are the main investigations that should be done?

What are the further investigations that may be done?

How is it managed?

Answer 2

➊ * ECG - Shortened QT interval, Osborn wave
* Bloods - LFTs, U&E, PTH
* Bone profile - Ca, pH, Albumin, ALP

➋ Depends on the suspected diagnosis:
* Urinary Bence-Jones proteins and plasma electrophoresis - myeloma
* Bone scan/PET scan - malignancy
* CXR - sarcoidosis, TB

➌ * Aggressive IV Fluids - Has to be given 1st! It corrects dehydration, protects kidneys and increases Ca excretion
* Bisphosphonates - inhibits osteoclast activity to reduce Ca release
‣ Pamindronate if no malignancy
‣ Zolendronic acid if known malignancy
* Further manage depending on the cause e.g. chemo, steroids