Hypercalcemia

Question 1

What is Hypercalcemia?

Answer 1

Hypercalcemia is defined as a serum calcium level of above 2.6 mmol/L

Question 2

What are the two factors considered in the calcium levels in Hypercalcemia?

Answer 2

The two factors considered are

Absolute level of calcium

Rate of change in calcium levels

Question 3

What are the three severity levels of Hypercalcemia?

Answer 3

The three severity levels are

3 mmol/L

3 - 3.5 mmol/L

>3.5 mmol/L

Question 4

What is the typical presentation of a patient with a calcium level of 3mmol/L?

Answer 4

The typical presentation in a calcium level of 3mmol/L is

Asymptomatic but require immediate correction to avoid symptoms

Question 5

What is the typical presentation of a patient with a calcium level of 3-3.5mmol/L?

Answer 5

The typical presentation of a patient with a calcium level of 3-3.5mmol/L is

Symtomatic if the rise was fast

Asymtomatic if slow rise

Question 6

What is the typical presentation of a patient with a calcium level of >3.5mmol/L?

Answer 6

The typical presentation of a patient with a calcium level of >3.5mmol/L is risk of dysrhythmia and coma

Question 7

What are the four parathyroid causes for Hypercalcemia?

Answer 7

The parathyroid causes of Hypercalcemia are

Primary hyperparathyroidism (sporadic)

Secondary hyperparathyroidism

Tertiary hyperthyroidism (renal failure)

Familial Hyprocalciuric hypercalcemia

Question 8

What are the non-parathyroid causes of Hypercalcemia?

Answer 8

The nonparathyroid causes for Hypercalcemia are

Malignancy

Vitamin D intoxication

Chronic granulomatous disorders - Sarcoidosis - TB

Question 9

What are the drug causes of Hypercalcemia?

Answer 9

The drug causes for Hypercalcemia are

Thiazide diuretics

Lithium

Teriparatide

Excessive vit A

Theophylline toxicity

Question 10

What are the miscellaneous causes of Hypercalcemia?

Answer 10

The miscellaneous causes of Hypercalcemia are

Hyperthyroidism

Acromegaly

Pheochromocytoma

Adrenal insufficiency

Immobilisation

Parenteral nutrition

Milk alkali syndrome

Question 11

What are the renal signs and symptoms of Hypercalcemia?

Answer 11

Table

Question 12

What are the gastrointestinal signs and symptoms of Hypercalcemia?

Answer 12

Table

Question 13

What are the musculoskeletal signs and symptoms of Hypercalcemia?

Answer 13

Table

Question 14

What are the neurological signs and symptoms of Hypercalcemia?

Answer 14

Table

Question 15

What are the cardiovascular signs and symptoms of Hypercalcemia?

Answer 15

Table

Question 16

What are the investigations used to confirm a diagnosis of Hypercalcemia?

Answer 16

The investigations used in Hypercalcemia are

U&Es

Ca levels

PO₂

Myleloma screening

Serum ACE

Parathyroid hormone test

ECG

Question 17

What non drug treatment is recommended for a patient with Hypercalcemia?

Answer 17

The non drug treatment is

Rehydration with 0.9% saline 4-6 litres over 24 hours

Question 18

What is the first line treatment for Hypercalcemia?

Answer 18

The 1st line treatment for Hypercalcemia is

IV bisphosphonates

Question 19

What are the four 2nd line treatments for Hypercalcemia?

Answer 19

The 2nd line treatments for Hypercalcemia are