Hypercalcemia

Question 1

Causes of hypercalcemia

Answer 1

HIGH CAL
High parathyroid hormone
Increased intake of calcium
Glucocorticoids usage (suppress calcium absorption in bone which leaves more calcium in blood)
Hyperthyroidism
Calcium excretion decreased (due to thiazide diuretic, renal failure and bone cancer)
Adrenal insufficiency
Lithium usage (affects the parathyroid and cause phosphate to decrease and calcium increase)

Question 2

Role of Addison’s disease for hypercalcemia

Answer 2

Reduce the amount of calcium the kidneys remove and increased the amount of calcium in the blood

Question 3

Role of thiazide diuretics in hypercalcemia

Answer 3

Reduce the amount of calcium excreted in urine and increased the calcium reabsorbed in the kidneys

Question 4

Clinical manifestations of hypercalcemia

Answer 4

Decreased neuromuscular excitability (sedation)
Lethargy, confusion
Muscle weakness
Bradycardia and heart block if severe
Kidney stones (calcium is excreted in the urine)
Constipation

Question 5

Intervention

Answer 5

IV fluids to promote renal excretion of calcium
Furosemide diuretics to promote renal calcium excretion
Biphosphonate (alendronate) to decreased calcium bone reabsorption
Calcitonin to stimulate renal calcium excretion
Look for any blood clots in lower legs, pelvic region
Administered calcium reabsorption inhibitors: Calcitonins, biphosphonates, prostaglandins synthesis inhibitors like aspirins, NSAIDS