HYPERCALCAEMIANURDALILA SAHIDAN4th YEAR MEDICAL STUDENT

CONTENTS Definition and Control of Calcium Epidemiology Signs and symptoms Causes Investigations Management Complications

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

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

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

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

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

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

COMPLICATIONS (UNTREATED, SEVERE

HYPERCALCEMIA) Osteoporosis Kidney stones Kidney failure Nervous system dysfunction Arrhythmia