Hypercalcaemia

Question 1

what is the normal range for serum calcium

Answer 1

2.2-2.6 mol/l

Question 2

how do you calculate corrected calcium

Answer 2

measured calcium + [0.02 x (40-alb)]

Question 3

what are causes of hypercalcaemia

Answer 3

bone mets

para-neoplastic syndrome - production of PTH-rp (parathyroid hormone-related peptide)
- typically produced by squamous cancers and HTLV-1 related T cell lymphomas

Question 4

what re the clinical features of hypercalcaemia

Answer 4

osmotic features - dehydration, polydipsia, polyuria
cognitive impairment, fatigue, lethargy, psychosis
constipation, nausea, vomiting
renal failure
cardiac arrhythmias

Question 5

what investigations should be done

Answer 5

serum Ca
PTH if cause unclear (suppressed if PTH-rp producing tumour)

usual bloods

Question 6

what is the management of hypercalcaemia

Answer 6

rehydration

• 4-6L 0.9% smile/24hrs if no CI
• loop diuretic if required eg frusemide

bisphosphonates
- zoledronate 4mg IV if renal function normal

calcitonin - rarely

steroids may benefit also