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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