Hypercalcaemia

Corrected calcium greater than 2.6 mmol /l

Treatment

• Rehydrate

• treat underlying cause

• palmidronate IV/PO

• steroids

Clinical Features

• General

  • malaise

  • tiredness

  • depression

• Renal

  • impaired ADH response

    • polyuria

    • dehydration

    • renal failure

  • calculi

  • nephrocalcinosis

• Neuromuscular

  • muscle weakness

  • tiredness

  • constipation

  • nausea

  • vomiting

  • abdominal pain

• Cardiac

  • risk of cardiac arrest with calcium >3.75 mmol/l

  • ECG changes (shortened QT interval)

  • hypertension

• CNS

  • impaired concentration

  • drowsiness

  • personality changes

  • anorexia, nausea, vomiting

  • coma

• Chondrocalcinosis

• corneal calcification

• vascular calcification

Causes

• Common

  • malignancy

  • primary hyperparathyroidism

Differentiation

• ↑ calcium,
  ↓ phosphate,
  ↑ parathyroid hormone (inappropriately)

  • Primary Hyperparathyroidism

  • Tertiary Hyperparathyroidism

  • Ectopic Parathyroid Hormone Production

  • Familial hypocalciuric hypercalcaemia

• ↑ calcium
  ↑ phosphate
  ↓ parathyroid hormone (appropriate)

  • malignancy (with or without bone metastasis)

  • thyrotoxicosis

  • Vitamin D intoxication

  • thiazide diuretics

  • renal transplantation

  • immobilisation (esp. Paget's Disease)

  • Acromegaly

  • adrenal failure

  • diuretic phase of acute renal failure

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