Hypercalcemia

Question 1

Define hypercalcemia.

Answer 1

Hypercalcemia is defined as elevated calcium levels in the blood above the normal range of 1 to 1.25 mmol/L

Question 2

What are the clinical features of hypercalcemia?

Answer 2

1. asymptomatic
2. nausea, anorexia
3. emotional lability, lethargy, stupor, coma
4. polyuria, kidney stones, hypovolemia
5. hypertension, heart block, arrhythmias
6. osteoporosis, bone pain

Question 3

What is the differential diagnosis for hypercalcemia?

Answer 3

1. hyperparathyroidism - primary, secondary, tertiary
2. vitamin D intoxication
3. malignancy
4. granulomatous disease (sarcoid, TB)
5. medications (thiazide diuretics, lithium, milk-alkali syndrome)
6. endocrine (hyperthyroidism, adrenal insufficiency, acromegaly, pheochromocytoma)
7. Immobilization
8. decreased calcium excretion (i.e., hypocalciuric hypercalcemia)

Question 4

What is the management of hypercalcemia?

Answer 4

1. assess and treat underlying cause
2. IV hydration with NS
3. Once volume replete, induce diuresis with loop diuretic
4. hemodialysis for life-threatening hypercalcemia
5. consult endocrinology regarding other treatments (bisphosphonates, glucocorticoids, calcitonin)