Hypercalcemia: Difference between revisions

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==Background==
==Background==
High >10.5 meq/L (>2.7 ionized)
*High >10.5 meq/L (>2.7 ionized)
*High! >12.0 meq/L
*90% of cases a/w malignancy or hyperparathyroidism


High! >12.0 meq/L


==Diagnosis==
==Diagnosis==
#stones (renal calculi)
#Stones (renal calculi)
#bones (bone destruction)
#Bones (bone destruction)
#psychic moanes (lethargy/confusion)
#abd groans (abd pain, N/V, constipation)
#abd groans (abd pain, constipation, polyuria, polydipsia)
#Psychic moans (lethargy/confusion)
#cardiac arrest (>20meq/L)
 
#ECG: shortened QT; heart block; depressed STs
 
#Polyuria, renal insufficiency
##Hypokalemia seen in 1/3 of pts
 
#ECG
##Prolonged PR & QRS
##Shortened QT
##Depressed ST
##Widened T waves
##Bradarrhythmias/ heart block


==Work-Up==
==Work-Up==
#check phosphate, amylase, ua
#Phosphate
#ekg for prolonged PR & QRS, decreased QT interval, heart block
#Lipase
#UA
#ECG


==DDX==
==DDX==
===Causes===
#Malignancy
#Hypothyroid
#Hyperparathyroidism
#Malignancy (mult myeloma, breast, lung, renal, leukemia, pancreatic)
#Lithium
#Thiazides
#Hypothyroidism
#Addison's
#Addison's
#Paget's
#Paget's
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#Milk-alkali synd
#Milk-alkali synd
#Excess vit D
#Excess vit D
#Thiazides
#Inc parathyroid


==Treatment==
==Treatment==
===Indications===
===Indications===
#>12.0 meq/L
#>14.0 meq/L
#symptomatic
#symptomatic
#unalbe to tolerated POs
#unable to tolerated PO
#abnl renal fx
#Abnl renal fx


===Treatment===
===Treatment===
#Correct dehydration (NS 5-10L)
#Volume repletion (NS 5-10L)
##aim UOP = 500cc/hr
##Goal UOP = 500cc/hr
#Lasix (40-200mg IV Q1-2hr PRN dec UOP)
#Decrease Ca mobilization from bone
##Pamidronate 90mg IV over 24 hours
##Zoledronic acid 4mg IV over 15 minutes
##Calcitonin 4 units/kg SubQ
#Correct hypokalemia/hypomagnesemia
#Correct hypokalemia/hypomagnesemia
#^Calcitonin 0.5-4 IU/kg IV over 24hrs
#Consider dialysis if anuric, ARF or CHF
#^Hydrocortisone 25-100mg IV Q6
#Furosemide is NOT recommended
#^Dialysis if anuric, RF, or CHF


^if Rxs 1-3 unsuccsessful


==See Also==
==See Also==
Hem/Onc: Hypercalcemia of Malignancy
[[Hypercalcemia of Malignancy]]


==Source ==
==Source ==
2/12/06 DONALDSON (adapted from Tintinalli, Mistry)
Tintinalli


[[Category:FEN]]
[[Category:FEN]]

Revision as of 05:34, 4 May 2011

Background

  • High >10.5 meq/L (>2.7 ionized)
  • High! >12.0 meq/L
  • 90% of cases a/w malignancy or hyperparathyroidism


Diagnosis

  1. Stones (renal calculi)
  2. Bones (bone destruction)
  3. abd groans (abd pain, N/V, constipation)
  4. Psychic moans (lethargy/confusion)


  1. Polyuria, renal insufficiency
    1. Hypokalemia seen in 1/3 of pts
  1. ECG
    1. Prolonged PR & QRS
    2. Shortened QT
    3. Depressed ST
    4. Widened T waves
    5. Bradarrhythmias/ heart block

Work-Up

  1. Phosphate
  2. Lipase
  3. UA
  4. ECG

DDX

  1. Malignancy
  2. Hyperparathyroidism
  3. Lithium
  4. Thiazides
  5. Hypothyroidism
  6. Addison's
  7. Paget's
  8. Sarcoid
  9. Hyperthyroid
  10. Milk-alkali synd
  11. Excess vit D

Treatment

Indications

  1. >14.0 meq/L
  2. symptomatic
  3. unable to tolerated PO
  4. Abnl renal fx

Treatment

  1. Volume repletion (NS 5-10L)
    1. Goal UOP = 500cc/hr
  2. Decrease Ca mobilization from bone
    1. Pamidronate 90mg IV over 24 hours
    2. Zoledronic acid 4mg IV over 15 minutes
    3. Calcitonin 4 units/kg SubQ
  3. Correct hypokalemia/hypomagnesemia
  4. Consider dialysis if anuric, ARF or CHF
  5. Furosemide is NOT recommended


See Also

Hypercalcemia of Malignancy

Source

Tintinalli

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