Hypercalcaemia

Hypercalcaemia is defined by a corrected calcium > 2.65 mmol/L. The most common causes of this are Primary Hyperparathyroidism and Malignancy. Other causes include:

• Thiazide diuretics

• Vit D intoxication

• Ca-containing drugs

• Sarcoidosis

• TB

• Familial Hypocalciuric Hypercalcaemia

Presentation

Stones, Bones, Groans and Psychiatric moans!

• Kidney stones

• Painful bones

• Abdominal groans - N+V, Constipation, Indigestion

• Psychiatric moans - Depression, Fatigue, Memory loss, Psychosis

Investigations

The main investigations to do include:

• ECG - Shortened QT interval, Osborn wave

• Bloods - LFTs, U&E

• Bone profile - Ca, pH, PTH, Albumin, ALP

Other investigations that may be done depends on the suspected diagnosis:

• Urinary Bence-Jones proteins and plasma electrophoresis - myeloma

• Bone scan/PET scan - malignancy

• CXR - sarcoidosis, TB

Management

• Aggressive IV Fluids - Has to be given 1st! It corrects dehydration, protects kidneys and increases Ca excretion

• Bisphosphonates - inhibits osteoclast activity to reduce Ca release

  • Give Pamindronate if no malignancy

  • Give Zolendronic acid if known malignancy

• Further manage depending on the cause e.g. chemo, steroids