Hypercalcaemia

Question 1

What is the normal range of calcium?

Answer 1

2.2 - 2.6mmol/l

Question 2

What are some of the etiological causes of hypercalcemia?

Answer 2

Bone metastases
Para-neoplastic syndrome
Production of PTH -related peptide - typically produced by squamous cancers and HTLV-1 related T cell lymphomas

Question 3

What are the osmotic features of hypercalcemia?

Answer 3

Dehydration
Polydipsia
Polyuria

Question 4

What are some of the other clinical features?

Answer 4

Cognitive impairment, fatigue, lethargy and psychosis
Constipation, nausea and vomiting
Renal failure
Cardiac arrhythmia

Question 5

What hormonal function should you check?

Answer 5

Check the PTH

Question 6

What are the 4 managements?

Answer 6

Rehydration - 4-6 litres 0.9% saline /24hrs if no contraindications
loop diuretic if required eg. frusemide
Biphosphonates - zoledronate 4mg iv if renal function normal
Calcitonin – rarely required
Steroids may be of benefit