Hypercalcaemia

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Hypercalcaemia

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

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