Hypercalcaemia

Definition

 

> 10 mg / dl

- must be corrected for albumin

 

Causes

 

Malignancy

- multiple myeloma / lung cancer / breast cancer

 

Hyperparathyroidism

- elevated PTH

 

Issue

 

High mortality associated with hypercalcaemia of malignancy

 

Physiology

 

40% albumin bound

50% ionised and active

 

Symptoms

 

Lethargy / confusion

- most commonly seen in malignancy

 

Kidney stones / abdominal pain / depression

- more likely seen in hyperparathyroidism

 

Management

 

Admit patient for medical management

 

Forced diuresis

- fluids + frusemide / loop diuretic

 

Bisphosphonates

- IV dose

 

Calcitonin

- gives rapid but short lived reduction

- need to be coadministered with other medications

 

Dialysis

- required if kidneys unable to cope with fluid diuresis / renal failure