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Serum calcium of >2.65mmol/L
'Bones, stones, groans and psychic moans'. I'm going to read something a figure what in God's name that means.
[Ten minutes later]
I found out I don't get what it means and have decided to split the symptoms like this.
- General - tiredness, weakness, fever
- GI - abdominal pain, vomiting, constipation, anorexia, weight loss
- Urinary Tract - polyuria (and polydipsia), renal stones, renal failure
- Head - corneal calcification, confusion, depression
- Cardiovascular - hypertension, reduced Q-T interval, cardiac arrest
- U+Es - mainly for serum calcium. Hopefully that's obvious. Also for magnesium, albumin, phosphate and creatinine.
- Serum calcium >3.5mmol/L
- Severe abdominal pain
- Fluids - 4-6L/24h iv 0.9% saline. Watch out for hypokalaemia/magnesaemia. Reduces symptoms and should increase renal calcium loss. Keep your eye on the U+Es.
- Diuretics - Furosemide 40mg po or iv 40mg/12h after rehydration. Do not use thiazides
- Bisphosphonates - single-dose pamidronate. Takes 2-3 days to work.
Others are steroids (40-60mg/24h) for sarcoid and salmon calcitonin but both of these are rarely used.
This is to determine cause.
- Raised albumin, raised urea - dehyrdation
- Raised/normal phosphate, raised alk phos - bone mets, sarcoidosis, thyrotoxicosis
- Raised phospate, normal alk phos - myeloma, vitamin D excess, sarcoidsosis
- Low/normal phosphate and albumin, normal urea - hyperparathyroidism