hypercalcemia Flashcards
Q: What is hypercalcemia?
A: Hypercalcemia refers to a serum calcium level above the upper limit of normal, often considered greater than 10.5 mg/dL.
Q: Why is calcium important in the body?
A: Calcium plays a vital role in myocardial contractility and nerve signaling.
Q: What can calcium imbalances, such as hypercalcemia, result in?
A: Cardiac and neurologic dysfunction.
Q: What are some important causes of hypercalcemia?
A: Medications, malignancy, and endocrine conditions like hyperparathyroidism or hyperthyroidism.
Q: What initial assessment should be performed if hypercalcemia is suspected?
A: Perform an ABCDE assessment to determine if the patient is unstable.
Q: How should you stabilize an unstable hypercalcemic patient?
A: Stabilize airway, breathing, and circulation, obtain IV access, continuous vital sign monitoring, and provide supplemental oxygen if needed.
Q: What are severe symptoms of hypercalcemia?
A: Lethargy, stupor, coma, bradycardia, atrioventricular block, or a shortened QT interval.
Q: How do you treat severe hypercalcemia?
A: Start intravenous hydration, diuretics like furosemide, or bisphosphonates like zoledronic acid.
Q: What should be done for stable patients with suspected hypercalcemia?
A: Obtain a focused history and physical examination, and check serum calcium levels.
Q: What symptoms might a patient with stable hypercalcemia report?
A: Personality and mood changes, trouble concentrating, altered mental status, abdominal pain, nausea, anorexia, constipation, musculoskeletal pain, polyuria, polydipsia, nephrolithiasis.
Q: What physical exam findings are typically seen in hypercalcemia?
A: Weakness and signs of dehydration like dry mucous membranes and poor skin turgor.
Q: What mnemonic helps remember the classic presentation of hypercalcemia?
A: “Groans, bones, stones, thrones, and psychiatric overtones.”
Q: What does “groans” represent in the mnemonic for hypercalcemia symptoms?
A: Constipation and muscle weakness due to decreased muscle contractions.
Q: What does “bones” represent in the mnemonic for hypercalcemia symptoms?
A: Bone pain resulting from chronic bone demineralization.
Q: What does “stones” represent in the mnemonic for hypercalcemia symptoms?
A: History of nephrolithiasis due to hypercalciuria.
Q: What does “thrones” represent in the mnemonic for hypercalcemia symptoms?
A: Polyuria.
Q: What do “psychiatric overtones” represent in the mnemonic for hypercalcemia symptoms?
A: Mood changes or altered mental status.
Q: Why should hypercalcemia be considered but not diagnosed immediately with high serum calcium levels?
A: Because half of the calcium in the blood is bound to plasma proteins like albumin, and ionized calcium reflects the body’s stores more accurately.
Q: How do you calculate the corrected total serum calcium level?
A: Subtract serum albumin from 4, multiply the difference by 0.8, then add the product to the measured serum calcium.
Q: What should be done once hypercalcemia is diagnosed?
A: Identify the cause by reviewing the patient’s medication list and checking serum parathyroid hormone (PTH) levels.
Q: What medications can cause hypercalcemia?
A: Vitamin D supplements, thiazide diuretics, lithium, and calcium-containing antacids.
Q: What does elevated PTH indicate in hypercalcemia?
A: Hyperparathyroidism.
Q: What are the types of hyperparathyroidism?
A: Primary, secondary, and tertiary hyperparathyroidism.
Q: What is Familial Hypocalciuric Hypercalcemia (FHH)?
A: An autosomal dominant genetic disorder that impacts the calcium-sensing receptor, leading to elevated PTH secretion despite hypercalcemia.
Q: How do you confirm a diagnosis of FHH?
A: Order a urine test to evaluate the calcium-to-creatinine ratio and proceed with genetic testing if the ratio is low.
Q: What labs should be ordered if PTH is not elevated in hypercalcemia?
A: PTH-related peptide, 1,25-dihydroxy vitamin D, and alkaline phosphatase.
Q: What does elevated PTH-related peptide indicate in hypercalcemia?
A: A possible solid tumor, such as lung cancer.
Q: What does high alkaline phosphatase suggest in hypercalcemia?
A: Lytic bone metastases, such as those seen in breast cancer or multiple myeloma.
Q: What conditions are indicated by elevated 1,25-dihydroxy vitamin D in hypercalcemia?
A: Lymphoma or granulomatous conditions like Hodgkin lymphoma or sarcoidosis.
Q: What should be considered if PTH-related peptide, alkaline phosphatase, and 1,25 dihydroxy vitamin D are normal?
A: Hyperthyroidism.
Q: What labs should be ordered to confirm hyperthyroidism in hypercalcemia?
A: TSH and free T4 levels.
Q: What indicates hyperthyroidism in the context of hypercalcemia?
A: Low TSH and high free T4 levels.
Q: What additional tests can be considered if the diagnosis of hypercalcemia is unclear?
A: Serum protein electrophoresis (SPEP) and urinary protein electrophoresis (UPEP).
Q: What is the purpose of SPEP and UPEP in hypercalcemia workup?
A: To look for the presence of monoclonal proteins, which would indicate diseases like multiple myeloma.
Q: What is the first step if you suspect hypercalcemia?
A: Perform a focused history and physical exam, and order serum calcium levels.
