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Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
Hypercalcaemia
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Hypercalcaemia

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  • 1. HYPERCALCAEMIA NURDALILA SAHIDAN 4th YEAR MEDICAL STUDENT
  • 2. CONTENTS
    • Definition and Control of Calcium
    • Epidemiology
    • Signs and symptoms
    • Causes
    • Investigations
    • Management
    • Complications
  • 3. DEFINITION AND CONTROL OF CALCIUM
    • Elevated calcium level in the blood
    • Normal range for serum calcium is 2.12-2.65 mmol/L
    • Parathyroid hormone (PTH)-Bone: calcium and phosphate reabsoprtion. Kidney: calcium but phosphate reabsorption. So serum calcium but serum phosphate
    • Vitamin D- converted to calcitriol in kidney. Lead to increase reabsorption in gut and kidney
    • Calcitonin - in plasma calcium and phosphate
  • 4. EPIDEMIOLOGY
    • An uncommon problem
    • Affect 4 in 100 000 population per year
    • Female > Male = 3:1
    • Peak age of incidence of 50-60 years old
  • 5. SIGNS AND SYMPTOMS
    • General mnemonic :
    • - Bones ( bone pain)
    • - Stones ( kidney stones)
    • - Groans ( constipations)
    • - Psychic moans ( fatigue, depression, confusion)
    • Other symptoms: abdominal pain, vomiting, polyuria, polydipsia, anorexia, weakness, hypertension, pyrexia, renal failure, cardiac arrest
  • 6. CAUSES
    • Primary Hyperparathyroidism
    • Malignancy : breast, lung, myeloma, bone metastases
    • Drugs : Vit D Intoxication, Thiazide, Vit A
    • Granulomatous : Sarcoidosis, Tuberculosis
    • Endocrine : Thyrotoxicosis, Phaeochromocytoma, Primary Adrenal Insufficient
    • Familial : Familial Hypocalciuric Hypercalcaemia
    • Others : dehydration, post-kidney transplant/chronic dialysis, prolonged immobilisation, milk-alkali syndrome, AIDS
  • 7. INVESTIGATIONS
    • Blood tests: calcium, phosphate, magnesium, creatinine, U&E, alk phos, PTH
    • CXR
    • CT scan / MRI / IVP
    • Mammogram
    • Low albumin, low chloride and an alkalosis suggest malignancy
    • Short QT interval in ECG
  • 8. MANAGEMENT
    • IV Fluid (0.9% saline eg 4-6 L in 24h as needed)
    • Correct electrolyte imbalance
    • Diuretics ( furosemide 40 mg/12h PO/IV. Avoid thiazide)
    • Treat underlying cause
    • Biphosphonates – Inhibits osteoclast. Max effect is at 1 wk
    • Steroids
    • Calcitonin (rarely used due to side effects)
    • Chemotherapy in malignancy
  • 9. COMPLICATIONS (UNTREATED, SEVERE HYPERCALCEMIA)
    • Osteoporosis
    • Kidney stones
    • Kidney failure
    • Nervous system dysfunction
    • Arrhythmia

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