Hypercalcaemia

Question 1

What are causes of hypercalcaemia?

Answer 1

Hyperparathyroidism (primary):
Malignancy: either metastases or secreting PTHrP, or myeloma

Others include
sarcoidosis
vitamin D intoxication
acromegaly
Milk-alkali syndrome
drugs: thiazides, calcium containing antacids, lithium
dehydration
Addison's disease
FHH
MEN1/2
immobility
hyperthyroidism

Question 2

what are Sx of hypercalcaemia

Answer 2

Muscle weakness, bone pain, OP
Nausea, constipation
Pancreatitis
Confusion, depression, fatigue
Polyuria, renal stones

Question 3

What Ix in hypercalcaemia

Answer 3

Ca high.
PTH high if hyperparathyroidism, FHH, lithium
PTH low if malignancy

For underlying cause:
myeloma screen
short synacthen
vit D 
look for cancer

Do ECG

Question 4

What types of cancer cause hypercalcaemia

Answer 4

Osteolytic mets
PTHrP: SCC lung, oesophageal, breast, RCC
Tumour making vit D e.g. lymphoma

Question 5

what is vit D toxicity

Answer 5

Taking too much vitamin D e.g. CKD, hypoparatyhroidism causes increased bone resorption and gut absorption

Question 6

What is milk alkali syndrome

Answer 6

Hypercalcaemia, metabolic acidosis, and renal insufficiency caused by ingestion of calcium and antacids

Question 7

What is rx of hypercalcaemia

Answer 7

FLUIDS
STOP offending agent

Bisphosphonates to stop bone resorption (take a while) and calcitonin to do this + increase renal Ca excretion quickly

Steroids depending on cause e.g. sarcoidosis, malignancy, vit D toxicity

can use loop diuretics, but these can interfere with electrolytes

Question 8

Complications of hypercalcaemia?

Answer 8

If high (>3.5), risk of arrhythmia and death