Malignant Hypercalcaemia

Question 1

What is the numerical definition of hypercalcaemia?

Answer 1

> 2.6mmol/L

Question 2

What percentage of patients get Malignant Hypercalcaemia?

Answer 2

10%

Question 3

What history should be asked in suspected hypercalcaemia?

Answer 3

1. Eating and drinking?
2. Urinary symptoms?
3. Vomiting?
4. Constipation?
5. Confusion?
6. Usual medications?

Question 4

What medications could increase calcium levels?

Answer 4

Supplementary calcium

• Thiazide diuretics
• Vitamin A
• Vitamin D

Question 5

How to treat low grade hypercalcaemia 2.6-2.9 asymptomatic

Answer 5

2.6-2.69

• Encourage oral hydration
• Recheck in 2 days

Question 6

How to treat Ca >3.0?

Answer 6

1. Stop medications
2. 3-4l fluids over 24 hours
3. Monitor renal function and escalate to renal/ICU if appropriate
4. Once rehydrated with good urine output and no improvement to hypercalcaemia can consider bisphosphonates e.g. zolendronic acid 4mg over 30 min (if renal function allows) (or pamidronate)
5. Monitor daily U&E, Ca, Mg and Phos
6. Do not repeat bisphosphonates for the next 4 days
7. if no improvement need to speak to an endocrinologist