Hypercalcemia

• • Elevated serum calcium

Symptoms and Signs

• • Fatigability

  • Muscle weakness

  • Depression

  • Anorexia

  • Nausea

  • Constipation

  • Polyuria

  • Polydipsia

  • Metastatic calcification

  • Coma

Laboratory Findings

• • Elevated serum calcium

• • 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)

• • 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

• • 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

References