Hypercalcaemia

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During her term as Secretary of State for Education and Science (1970-1974), Ms Thatcher was known as 'Margaret Thatcher, milk snatcher'. She then developed hypercalcaemia from excessive calcium consumption.

Definition

Serum calcium of >2.65mmol/L

Epidemiology

Common.jpg

Pathophysiology

The most common causes are malignancy (usually myeloma or bone metastases) or hyperparathyroidism. Other causes include vitamin D intoxication, sarcoidosis and some other crazy rare ones.

Risk Factors

Clinical Features

'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.

Investigations

  • U+Es - mainly for serum calcium. Hopefully that's obvious. Also for magnesium, albumin, phosphate and creatinine.

Management

Treat if:

  • Serum calcium >3.5mmol/L
  • Severe abdominal pain
  • Vomiting
  • Fever
  • Confusion

Treatment

  • 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.

Further investigation

This is to determine cause.

Prognosis