Hypercalcemia

Background

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

Clinical Features

1. Stones
   1. Renal calculi
2. Bones
   1. Bone pain/destruction
3. Groans
   1. Abd pain, N/V, constipation
4. Moans
   1. Lethargy/confusion
5. Also:
   1. Polyuria/polydipsia
   2. Dehydration
   3. Renal insufficiency

Diagnosis

1. ECG
   1. Prolonged PR & QRS
   2. Shortened QT
   3. Depressed ST
   4. Widened T waves
   5. Bradarrhythmias/ heart block

Work-Up

1. Calcium
2. Phosphate
3. Lipase
4. UA
5. 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. Abnormal renal function

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