Hypercalcaemia

Question 1

What is the equation for corrected Ca?

Answer 1

[(40-serum albumin) x 0.02] + measured Ca

Question 2

What is the normal range for Ca?

Answer 2

2.25-2.58

Question 3

What is are some symptoms of hypercalcaemia?

Answer 3

Nausea and vomiting
Constipation
Depression
Polyuria and polydipsia
Confusion
Anorexia
Coma 
Seizures

Question 4

What are some causes of hypercalcaemia?

Answer 4

Bone resorption

• Excessive PTH - primary producing adenoma or paraneoplastic effect
• Malignancy - mets or MM

Increased GIT absorption (increased 25-OH vitamin D)

• Lymphoma
• Granulomatous diseases eg sarcoid

Decreased renal excretion
- Drugs such as lithium and diuretics

(Primary hyperPTH and malignancy are the most common)

Question 5

How do you investigate hypercalcaemia?

Answer 5

PTH
PTHrP (PTH-related protein)
ACE (sarcoid)
Serum electrophoresis, bone scan, CXR (malignancies)
25-OH vitamin D

Question 6

What are some complications of hypercalcaemia?

Answer 6

Nephrolithiasis
Prolonged QT = Arrhthymias
Peptic ulcer disease
Pancreatitis

Question 7

How is hypercalcaemia mx?

Answer 7

1. Vigorous rehydration with normal saline - initially up to 500ml/hour depending on cardiovascular/renal status
2. Loop diuretics - once hydrated, they promote urinary calcium excretion
3. IV bisphosphonates (if bone resorption is occurring)
4. Corticosteroids (reduce GIT Ca absorption)
5. Treat the underlying disease