Hypercalcemia

Question 1

What are the common causes of hypercalcaemia?

Answer 1

Malignancy - bone mets, myeloma, lymphoma, PTHrP
or
Primary hyperparathyroidism
(together 90%)

Question 2

How do you differentiate between PTH and non-PTH driven hypercalcaemia?

Answer 2

Measure PTH

If PTH is high it’s primary hyperparathyroidism (more common), familial hypocalciuric hypercalcaemia or tertiary hyperparathyroidism

If PTH is low it is hyperecalcaemia of malignancy or another rarer cause

Question 3

What is the emergency management of hypercalcaemia?

Answer 3

ECG - prolongued QT
IV fluids: SALINE 4-6L over 24h (will have lost sodium)
Look for a cause
Consider:
IV Zoledronate
Steroids (lymphoma or granulomatous disease)

Question 4

What are the common symptoms of hypercalcaemia?

Answer 4

Thirst and Polyuria
Nausea
Constipation
Confusion –> Coma

Question 5

What signs may be seen in hypercalcaemia?

Answer 5

Renal stones

ECG changes/ arrythmias

Question 6

What ECG change is seen in hypercalcaemia?

Answer 6

Short QT

Question 7

What drugs may cause hypercalcaemia by increasing reabsorption?

Answer 7

Thiazide-diuretics

Question 8

What level of calcium would be considered an emergency?

Answer 8

Emergency if aCa >3.0 mmol/l