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  • • Elevated serum calcium

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Symptoms and Signs

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  • • Fatigability

    • Muscle weakness

    • Depression

    • Anorexia

    • Nausea

    • Constipation

    • Polyuria

    • Polydipsia

    • Metastatic calcification

    • Coma

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Laboratory Findings

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  • • Elevated serum calcium

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  • • Hyperparathyroidism

    • Cancer with bone metastases

    • Ectopic parathyroid hormone (PTH) production

    • Vitamin D intoxication

    • Hyperthyroidsm

    • Milk-alkali syndrome

    • Prolonged immobilization

    • Thiazide diuretics

    • Addison disease

    • Familial Hypocalciuric hypercalcemia (FHH)

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  • • Physical exam

    • Measure PTH

    • Elevated or non-suppressed PTH with elevated calcium implies primary hyperparathyroidism

    • Suppressed PTH implies normal parathyroid function; most common diagnosis is malignancy

    • Mild elevation of PTH and calcium can by FHH

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  • • If severe (> 14.5 mg/dL), IV isotonic saline to decrease serum calcium by dilution and diuresis

    • Lasix

    • IV sodium sulfate

    • Plicamycin is useful to treat those with metastatic cancer

    • Corticosteroids for sarcoidosis, vitamin D intoxication, and Addison disease

    • Calcitonin can be useful for patients with impaired renal or cardiac function who might not tolerate forced diuresis

    • Hemodialysis in renal failure

    • Operative correction for hyperparathyroidism

    • No therapy needed for FHH

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References

Body JJ. Current and future directions in medical therapy: Hypercalcemia. Cancer. 2000;88(12 Suppl):3054.
Ziegler R. Hypercalcemic crisis. J Am Soc Nephrol. 2001;12(Suppl 17):S3.
Shepard MM. Smith JW 3rd. Hypercalcemia. American Journal of the Medical Sciences. 2007, 334(5):381-5.  [PubMed: 18004092]

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