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Hypercalcemia final
This document discusses hypercalcemia, defined as a serum calcium level above 10.3 mg/dl. It lists the main causes as primary hyperparathyroidism, malignancy like multiple myeloma and breast cancer, and excess vitamin D. Symptoms involve the renal, musculoskeletal, gastrointestinal and neurological systems and include nephrolithiasis, bone pain, nausea and confusion. Emergency treatment involves rehydration with IV saline and bisphosphonates while medical management focuses on fluid intake, diet modification and exercise. Specific treatments address the underlying cause such as surgery for primary hyperparathyroidism or treating the malignancy.
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Hypercalcemia final
- 1.
- 2. DEFINITION • Total S.Ca >10.3 mg/dl + Normal S. Albumin • Ionized S. Ca > 5.2 mg/dl
- 3. CAUSES 1. Related toPTH 2. Malignancy 3. Vitamin D-related 4. Medications 5. Other endocrine 6. Genetic 7. Other
- 4. PTH Related • Primaryhyperparathyroidism • Adenoma(s) • MEN I or II • Carcinoma • Familial hypocalciuric hypercalcemia • Tertiary hyperparathyroidism • CRF • Vitamin D deficiency
- 5. Malignancy related • Humoralhypercalcemia (mediated by PTHrP) • Solid tumors • Lung • Head and neck squamous cancers • Renal cell tumors • Local osteolysis (mediated by cytokines) • Multiple myeloma • Ectopic Vit D3 secretion • Hodgkin’s lymphoma
- 6. Vitamin D related •Vitamin D intoxication • Granulomatous disease • Sarcoidosis • Berylliosis • Tuberculosis • Hodgkin’s lymphoma
- 7. Medications • Thiazide diuretics(usually mild) • Lithium • Milk-alkali syndrome (from calcium antacids) • Vitamin A intoxication (including analogs used to treat acne)
- 8. Endocrine disorders • Hyperthyroidism •Adrenal insufficiency • Acromegaly • Pheochromocytoma
- 9. Genetic disorders • Familialhypocalciuric hypercalcemia • Mutated calcium-sensing receptor • Normal PTH in 80-85% of patients • Benign inherited condition
- 10. Others • Immobilization • Highbone turnover • Paget’s disease, bedridden child • Recovery phase of rhabdomyolysis
- 11. MOST COMMON • Primaryhyperparathyroidism • Malignancy • Multiple myeloma • Breast carcinoma • Account for 90% cases
- 12. SYMPTOMS • Renal • Musculoskeletal •Gastrointestinal • Neurological • Cardiac • Others
- 13. Renal • Nephrolithiasis • Nephrocalcinosis •Polyuria • Polydipsia
- 14. Musculoskeletal • Bone pain •Osteopenia • Fractures • Muscular weakness, especially proximal myopathy
- 15. Gastrointestinal • Nausea • Vomiting •Lack of appetite • Constipation • Peptic ulcers • Pancreatitis
- 16. Neurological • Tiredness • Lethargy •Inability to concentrate • Increased sleepiness • Depression • Confusion • Coma
- 17. Cardiac • Bradycardia • First-degreeAV block • Arrhythmias • Shortened QT interval
- 18. Others • Itching • Keratitis •Conjunctivitis • Corneal calcification, band keratopathy • Carpal tunnel syndrome • Occasionally with hyperparathyroidism
- 19.
- 20. TREATMENT EMERGENCY • Rehydrate:- •4–6 L of 0.9% saline on day 1 • 3–4 L for several days thereafter • Intravenous bisphosphonates:- • Hypercalcaemia of malignancy • Undiagnosed cause • Pamidronate, Zoledronate • Prednisolone:- • Myeloma, Sarcoidosis, Vitamin D excess (ineffective usually) • Calcitonin:- • Short-lived action • Oral phosphate
- 21. TREATMENT MEDICAL • Highfluid intake • Avoid high calcium intake • Avoid high vitamin D intake • Exercise
- 22. TREATMENT SPECIFIC • Primaryhyperparathyroidism – Sx • Malignancy – Rx for malignancy • Vit D excess – ↓ Vit D intake • Avoid ppting drugs • Treat endocrine disorders • Treat CRF