Hypercalcaemia

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

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.

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.

• 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

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.

• 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