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Diagnosis > Hypercalcaemia > Flashcards

Hypercalcaemia Flashcards

1
Q

When can a result of hypercalcaemia be trusted to be a true pathological finding?

A

When the specimen was tkaen without a venous cuff, and the result has been corrected for albumin concentration

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2
Q

What is considered to be severe hypercalcaemia?

A

Calcium >3.5mmol/L

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3
Q

How is severe hypercalcaemia managed?

A
  • Saline infusion and furosemide, to maintain fluid balance and prevent fluid overload
  • Correct hypokalaemia and hypomagnesaemia
  • If calcium remains high, pamidronate disodium over 2-3 days
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4
Q

What are the main differential diagnoses for hypercalcaemia?

A
  • Thiazide diuretics
  • Bone metastases
  • Thyrotoxicosis
  • Primary or tertiary hyperparathyroidism
  • Myeloma
  • Sarcoidosis
  • Vitamin D excess
  • Ectopic parathyroid hormone
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5
Q

What suggests that thiazide diuretics are the cause of hypercalcaemia?

A
  • Mild hypercalcaemia
  • Drug history
  • Normal phosphate and alkaline phosphatase
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6
Q

What confirms that thiazide diuretics are the cause of hypercalcaemia?

A

Normal calcium when drug stopped

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7
Q

Where are the common sources of bone metastases?

A
  • Breast
  • Bronchus
  • Kidney
  • Thyroid
  • Ovary
  • Colon
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8
Q

What suggests that bone metastases are the cause of hypercalcaemia?

A
  • Normal phosphate
  • Increased alkaline phosphatase
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9
Q

What confirms that bone metastases are the cause of hypercalcaemia?

A

Secondaries on bone scan

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10
Q

How is hypercalcaemia caused by bone metastases managed?

A
  • Pamidronate over 2-3 days to lower calcium
  • Approrpriate treatment of neoplastic process
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11
Q

What suggests that thyrotoxicosis is the cause of hypercalcaemia?

A
  • Weight loss with good appetite
  • Tremor
  • Palpitations
  • Agitation
  • Goitre
  • Mildly increased calcium
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12
Q

How is it confirmed that thyrotoxicosis is the cause of hypercalcaemia?

A
  • Increased T3 or T4
  • Greatly decreased TSH
  • Normal phosphate and alkaline phosphatase
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13
Q

How is thyrotoxicosis managed?

A
  • Propanolol o control symptoms
  • Carbimazole
  • Written warning about agranulocytosis
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14
Q

What suggests that hypercalcaemia is caused by primary or tertiary hyperparathyroidism?

A
  • Fatigue
  • Constipation
  • Depression
  • Impaired memory
  • Renal colic and kidney stones
  • Stomach ulcer
  • Increased BP
  • Pancreatitis
  • Low phosphate and increased alkaline phosphatase
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15
Q

What confirms that hypercalcaemia is caused by hyperparathyroidism?

A

Increased plasma parathyroid levels

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16
Q

What suggests that hypercalcaemia is caused by myeloma?

A
  • Low back pain
  • Polyuria and polydipsia
  • Spinal fracture
  • Normal serum phosphate and alkaline phosphatase
17
Q

What confirms that myeloma is the cause of hypercalcaemia?

A
  • Paraprotein with immunoparesis on electrophoresis
  • Hypercalcaemia
  • Decreased Hb
  • Bence-Jones protein in urine
  • Spinal x-ray showing fracture with osteolytic lesion
18
Q

How is myeloma treated?

A
  • Correct very high calcium, and oral bisphosphonate to keep calcium down
  • Analgesics for bone pain
  • Local radiotherapy in progressive disease
  • Prompt treatment of infections
  • Transfusions for anaemia
  • Chemotherapy using melphalan or cyclophosphamide in conjunction with steroids
19
Q

What suggests that hypercalcaemia is caused by sarcoidosis?

A
  • Cough
  • Weight loss
  • Night sweats
  • Shortness of breath
  • Erythema nodusum
  • Increased phosphate and alkaline phosphatase
  • Bilateral hilar shadows on CXR
20
Q

What confirms that sarcoidosis is the cause of hypercalcaemia?

A
  • Lung function tests
  • Kveim test
  • Biopsy from granuloma
  • Increased vitamin D levels
  • Increased ACE levels
21
Q

How is hypercalcacemia in sarcoidosis managed?

A
  • Correct very high calcium, and long-term prednisolone to control calcium
  • In severe cases, methylprednisolone IV or immunosuppression
22
Q

What suggests that vitamin D excess is the cause of hypercalcaemia?

A
  • Drug history
  • Increased phosphate
23
Q

What confirms that vitamin D excess is the cause of hypercalcaemia?

A

Normal calcium when drug stopped

24
Q

What is usually the cause of ectopic parathyroid hormone?

A

Lung cancer

25
Q

What suggests that ectopic parathyroid production is the cause of hypercalcaemia?

A

Decreased phosphate and increased alkaline phosphatase

26
Q

What confirms that ectopic parathyroid hormone production due to lung cancer is the cause of hypercalcaemia?

A

High plasma parathyroid with presence of neoplasm

Diagnosis (11 decks)

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