calcium
Hypercalcaemia
Causes
- Primary hyperparathyroidism and malignancy are the two most common causes of increased serum calcium levels
- If PTH levels are detectable, generally speaking the cause of hyper Ca++ is primary hyperparathyroidism
- other causes include: sarcoidosis, thyrotoxicosis
Clinical
- Anorexia, nausea and constipation
- abdo pain - constipation, ileus, pancreatitis, Pancreatitis, Peptic ulceration
- Muscle weakness
- Renal impairment: Polyuria and polydipsia, nephrogenic diabetes insipidus, Nephrolithiasis and nephrocalcinosis
- Mood disturbance, cognitive dysfunction, confusion, fatigue and coma
- Cardiovascular: Shortened QT interval and dysrhythmias, Cardiomyopathy, Hypertension
Management
- Management depends on acuity of change:
- Adjusted calcium <3mmol/L: often asymptomatic and does not require urgent correction, however discuss with the endocrine team.
- Adjusted calcium 3-3.5mmol/L: may be tolerated if level has risen slowly, however may be symptomatic and prompt treatment is usually indicated.
- Adjusted calcium >3.5mmol/L: requires urgent correction due to the risk of dysrrhythmia and coma.
- Emergency Mx
- IV saline
- IV bisphosphonate if no success
- Zoledronic acid 4mg over 15minutes or
- Pamidronate 30-90mg at 20mg/hour
- Other agents: calcitonin (100U SC per 6-8/24 or ≤10U/kg IV over 6/24 in emergency), dialysis, mithramycin and also anti-resorptive agent denosumab