hypercalcemia

Question 1

Q: What is hypercalcemia?

Answer 1

A: Hypercalcemia refers to a serum calcium level above the upper limit of normal, often considered greater than 10.5 mg/dL.

Question 2

Q: Why is calcium important in the body?

Answer 2

A: Calcium plays a vital role in myocardial contractility and nerve signaling.

Question 3

Q: What can calcium imbalances, such as hypercalcemia, result in?

Answer 3

A: Cardiac and neurologic dysfunction.

Question 4

Q: What are some important causes of hypercalcemia?

Answer 4

A: Medications, malignancy, and endocrine conditions like hyperparathyroidism or hyperthyroidism.

Question 5

Q: What initial assessment should be performed if hypercalcemia is suspected?

Answer 5

A: Perform an ABCDE assessment to determine if the patient is unstable.

Question 6

Q: How should you stabilize an unstable hypercalcemic patient?

Answer 6

A: Stabilize airway, breathing, and circulation, obtain IV access, continuous vital sign monitoring, and provide supplemental oxygen if needed.

Question 7

Q: What are severe symptoms of hypercalcemia?

Answer 7

A: Lethargy, stupor, coma, bradycardia, atrioventricular block, or a shortened QT interval.

Question 8

Q: How do you treat severe hypercalcemia?

Answer 8

A: Start intravenous hydration, diuretics like furosemide, or bisphosphonates like zoledronic acid.

Question 9

Q: What should be done for stable patients with suspected hypercalcemia?

Answer 9

A: Obtain a focused history and physical examination, and check serum calcium levels.

Question 10

Q: What symptoms might a patient with stable hypercalcemia report?

Answer 10

A: Personality and mood changes, trouble concentrating, altered mental status, abdominal pain, nausea, anorexia, constipation, musculoskeletal pain, polyuria, polydipsia, nephrolithiasis.

Question 11

Q: What physical exam findings are typically seen in hypercalcemia?

Answer 11

A: Weakness and signs of dehydration like dry mucous membranes and poor skin turgor.

Question 12

Q: What mnemonic helps remember the classic presentation of hypercalcemia?

Answer 12

A: “Groans, bones, stones, thrones, and psychiatric overtones.”

Question 13

Q: What does “groans” represent in the mnemonic for hypercalcemia symptoms?

Answer 13

A: Constipation and muscle weakness due to decreased muscle contractions.

Question 14

Q: What does “bones” represent in the mnemonic for hypercalcemia symptoms?

Answer 14

A: Bone pain resulting from chronic bone demineralization.

Question 15

Q: What does “stones” represent in the mnemonic for hypercalcemia symptoms?

Answer 15

A: History of nephrolithiasis due to hypercalciuria.

Question 16

Q: What does “thrones” represent in the mnemonic for hypercalcemia symptoms?

Answer 16

A: Polyuria.

Question 17

Q: What do “psychiatric overtones” represent in the mnemonic for hypercalcemia symptoms?

Answer 17

A: Mood changes or altered mental status.

Question 18

Q: Why should hypercalcemia be considered but not diagnosed immediately with high serum calcium levels?

Answer 18

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.

Question 19

Q: How do you calculate the corrected total serum calcium level?

Answer 19

A: Subtract serum albumin from 4, multiply the difference by 0.8, then add the product to the measured serum calcium.

Question 20

Q: What should be done once hypercalcemia is diagnosed?

Answer 20

A: Identify the cause by reviewing the patient’s medication list and checking serum parathyroid hormone (PTH) levels.

Question 21

Q: What medications can cause hypercalcemia?

Answer 21

A: Vitamin D supplements, thiazide diuretics, lithium, and calcium-containing antacids.

Question 22

Q: What does elevated PTH indicate in hypercalcemia?

Answer 22

A: Hyperparathyroidism.

Question 23

Q: What are the types of hyperparathyroidism?

Answer 23

A: Primary, secondary, and tertiary hyperparathyroidism.

Question 24

Q: What is Familial Hypocalciuric Hypercalcemia (FHH)?

Answer 24

A: An autosomal dominant genetic disorder that impacts the calcium-sensing receptor, leading to elevated PTH secretion despite hypercalcemia.

Question 25

Q: How do you confirm a diagnosis of FHH?

Answer 25

A: Order a urine test to evaluate the calcium-to-creatinine ratio and proceed with genetic testing if the ratio is low.

Question 26

Q: What labs should be ordered if PTH is not elevated in hypercalcemia?

Answer 26

A: PTH-related peptide, 1,25-dihydroxy vitamin D, and alkaline phosphatase.

Question 27

Q: What does elevated PTH-related peptide indicate in hypercalcemia?

Answer 27

A: A possible solid tumor, such as lung cancer.

Question 28

Q: What does high alkaline phosphatase suggest in hypercalcemia?

Answer 28

A: Lytic bone metastases, such as those seen in breast cancer or multiple myeloma.

Question 29

Q: What conditions are indicated by elevated 1,25-dihydroxy vitamin D in hypercalcemia?

Answer 29

A: Lymphoma or granulomatous conditions like Hodgkin lymphoma or sarcoidosis.

Question 30

Q: What should be considered if PTH-related peptide, alkaline phosphatase, and 1,25 dihydroxy vitamin D are normal?

Answer 30

A: Hyperthyroidism.

Question 31

Q: What labs should be ordered to confirm hyperthyroidism in hypercalcemia?

Answer 31

A: TSH and free T4 levels.

Question 32

Q: What indicates hyperthyroidism in the context of hypercalcemia?

Answer 32

A: Low TSH and high free T4 levels.

Question 33

Q: What additional tests can be considered if the diagnosis of hypercalcemia is unclear?

Answer 33

A: Serum protein electrophoresis (SPEP) and urinary protein electrophoresis (UPEP).

Question 34

Q: What is the purpose of SPEP and UPEP in hypercalcemia workup?

Answer 34

A: To look for the presence of monoclonal proteins, which would indicate diseases like multiple myeloma.

Question 35

Q: What is the first step if you suspect hypercalcemia?

Answer 35

A: Perform a focused history and physical exam, and order serum calcium levels.