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Hypercalcemia
Definitions:
– The normal reference range of serum calcium levels in adults is 8.7-10.4 mg/dL
– Mild hypercalcemia is 10.5 – 11.9 mg/dL
– Moderate hypercalcemia is 12.0-13.9 mg/dL
– Severe hypercalcemia is > 14.0 mg/dL
Epidemiology:
-Primary hyperparathyroidism is most common cause of mild hypercalcemia, with over 50,000 new cases per year.
– 20-40% of patients with cancer develop hypercalcemia at some point in disease
-Prognosis of hypercalcemia associated with malignancy is poor; 1 year survival rate of 10-30%
Presentation:
-Moans, groans, stones, bones, psychic overtones
-Mild elevations usually have few or no symptoms
– Nausea; vomiting; ams; abdominal pain; constipation; generalized weakness and fatigue; joint pains; headache; confusion; lethargy; depression; polyuria, polydipsia, nocturia.
Causes:
- Primary hyperparathyroidism – PTH mediated
- Non-PTH mediated
- Malignancy
- Granulomatous disorders (increased calcitriol production from macrophages)
- Iatrogenic
- Pharmacologic agents (i.e. thiazide, lithium, calcium carbonate, hypervitaminosis D)
- Endocrinopathies (nonparathyroid)
- Familial hypocalciuric hypercalcemia
- Tertiary hyperparathyroidism
Workup:
– Correct for total calcium based on albumin
– Get an ionized calcium
– EKG – Changes include QT interval shortening, prolonged PR interval
Treatment
– IVF hydration
– Loop diuretics
– Bisphosphonates
– Calcitonin
– Discontinue contributing pharmacologic agents
– Underlying cause (when possible)
– Dialysis for severe cases with renal failure
References:
- Stewart F. Hypercalcemia Associated With Cancer.N Engl J Med. 2005; 352:373-379
- Hemphill R. (April 2013) Hypercalcemia in Emergency Medicine. Emedicine. Emedicine.medscape.com.
Jay Khadpe MD
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