Hypercalcemia is elevated calcium levels in the blood. Normal calcium levels are 2.12-2.65 mmol/L. It is uncommon, affecting 4 in 100,000 people per year, and more common in females ages 50-60. Signs and symptoms include bone pain, kidney stones, constipation, fatigue, and renal failure. Causes include primary hyperparathyroidism, malignancy, certain drugs, and granulomatous diseases. Diagnosis involves blood and imaging tests. Treatment consists of IV fluids, correcting electrolyte imbalances, diuretics, treating the underlying cause, bisphosphonates, steroids, and calcitonin. Untreated severe hypercalcemia can lead to osteop

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