Hypercalcaemia & Osteomalacia

Question 1

What are normal levels of calcium in blood?

Answer 1

2.25 – 2.5 mmol/l

Question 2

What are the main causes of hypercalcaemia?

Answer 2

Main cause is primary hyperparathyroidism and mostly effects post-menopausal women. Non-PTH mediated hypercalcaemia is usually related to malignancy, TB, endocrine conditions, drugs, family history or prolonged immobilisation.

Question 3

Give some symptoms of hypercalcaemia

Answer 3

3,5 mmol
abdo pain
vomiting
dehydration
lethargy
Cardiac arrhythmias
Coma

Question 4

Give three investigations for hypercalcaemia

Answer 4

Corrected calcium level – Hyperparathyroidism is usually lower than other 6 months.
PTH levels
X-rays will should bone abnormality

Question 5

What is management of acute hypercalcaemia

Answer 5

• Increasing the circulating volume with 0.9% saline helps increase urinary output of calcium
• Furosemide
• Bisphosphonates

Question 6

What is management of PTH mediated hypercalcaemia

Answer 6

• Asymptomatic patients can be treated conservatively with regular bone density, renal function and serum and urinary calcium levels
• Dietary calcium can be reduced
• Symptomatic patients can have some of the parathyroid removed

Question 7

What is osteogenesis imperfecta?

Answer 7

Inherited condition causing increased bone fragility due to defect in collagen type 1. Usually autosomal dominant.

Question 8

Give some clinical signs of osteogenesis imperfecta

Answer 8

Blue sclera, dental issues, hypermobility and hearing issues are common. Cardiac effects – aortic incompetence, mitral valve prolapse – are important.

Question 9

Give three ways of managing OI

Answer 9

Management includes bisphosphonates, intramedullary rod placement, soft tissue surgery for lower limb contracture