Hypercalcemia: Difference between revisions

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==Background==
==Background==
High >10.5 meq/L (>2.7 ionized)
High >10.5 meq/L (>2.7 ionized)


High! >12.0 meq/L
High! >12.0 meq/L


==Diagnosis==
==Diagnosis==
 
#stones (renal calculi)
 
#bones (bone destruction)
1) stones (renal calculi)
#psychic moanes (lethargy/confusion)
 
#abd groans (abd pain, constipation, polyuria, polydipsia)
2) bones (bone destruction)
#cardiac arrest (>20meq/L)
 
#ECG: shortened QT; heart block; depressed STs
3) psychic moanes (lethargy/confusion)
 
4) abd groans (abd pain, constipation, polyuria, polydipsia)
 
5) cardiac arrest (>20meq/L)
 
ECG: shortened QT; heart block; depressed STs
 


==Work-Up==
==Work-Up==
 
#check phosphate, amylase, ua
 
#ekg for prolonged PR & QRS, decreased QT interval, heart block
1) check phosphate, amylase, ua
 
2) ekg for prolonged PR & QRS, decreased QT interval, heart block
 


==DDX==
==DDX==
===Causes===
===Causes===
 
#Hypothyroid
 
#Malignancy (mult myeloma, breast, lung, renal, leukemia, pancreatic)
1) Hypothyroid
#Addison's
 
#Paget's
2) Malignancy (mult myeloma, breast, lung, renal, leukemia, pancreatic)
#Sarcoid
 
#Hyperthyroid
3) Addison's
#Milk-alkali synd
 
#Excess vit D
4) Paget's
#Thiazides
 
#Inc parathyroid
5) Sarcoid
 
6) Hyperthyroid
 
7) Milk-alkali synd
 
8) Excess vit D
 
9) Thiazides
 
10) Inc parathyroid
 


==Treatment==
==Treatment==
===Indications===
===Indications===
 
#>12.0 meq/L
 
#symptomatic
1) >12.0 meq/L
#unalbe to tolerated POs
 
#abnl renal fx
2) symptomatic
 
3) unalbe to tolerated POs
 
4) abnl renal fx
 


===Treatment===
===Treatment===
#Correct dehydration (NS 5-10L)
##aim UOP = 500cc/hr
#Lasix (40-200mg IV Q1-2hr PRN dec UOP)
#Correct hypokalemia/hypomagnesemia
#^Calcitonin 0.5-4 IU/kg IV over 24hrs
#^Hydrocortisone 25-100mg IV Q6
#^Dialysis if anuric, RF, or CHF


 
^if Rxs 1-3 unsuccsessful
1) Correct dehydration (NS 5-10L)
 
-aim UOP = 500cc/hr
 
2) Lasix (40-200mg IV Q1-2hr PRN dec UOP)
 
3) Correct hypokalemia/hypomagnesemia
 
4) *Calcitonin 0.5-4 IU/kg IV over 24hrs
 
5) *Hydrocortisone 25-100mg IV Q6
 
6) *Dialysis if anuric, RF, or CHF
 
*if Rxs 1-3 unsuccsessful
 


==See Also==
==See Also==
Hem/Onc: Hypercalcemia of Malignancy
Hem/Onc: Hypercalcemia of Malignancy


==Source ==
==Source ==
2/12/06 DONALDSON (adapted from Tintinalli, Mistry)
2/12/06 DONALDSON (adapted from Tintinalli, Mistry)


[[Category:FEN]]
[[Category:FEN]]

Revision as of 20:04, 13 March 2011

Background

High >10.5 meq/L (>2.7 ionized)

High! >12.0 meq/L

Diagnosis

  1. stones (renal calculi)
  2. bones (bone destruction)
  3. psychic moanes (lethargy/confusion)
  4. abd groans (abd pain, constipation, polyuria, polydipsia)
  5. cardiac arrest (>20meq/L)
  6. ECG: shortened QT; heart block; depressed STs

Work-Up

  1. check phosphate, amylase, ua
  2. ekg for prolonged PR & QRS, decreased QT interval, heart block

DDX

Causes

  1. Hypothyroid
  2. Malignancy (mult myeloma, breast, lung, renal, leukemia, pancreatic)
  3. Addison's
  4. Paget's
  5. Sarcoid
  6. Hyperthyroid
  7. Milk-alkali synd
  8. Excess vit D
  9. Thiazides
  10. Inc parathyroid

Treatment

Indications

  1. >12.0 meq/L
  2. symptomatic
  3. unalbe to tolerated POs
  4. abnl renal fx

Treatment

  1. Correct dehydration (NS 5-10L)
    1. aim UOP = 500cc/hr
  2. Lasix (40-200mg IV Q1-2hr PRN dec UOP)
  3. Correct hypokalemia/hypomagnesemia
  4. ^Calcitonin 0.5-4 IU/kg IV over 24hrs
  5. ^Hydrocortisone 25-100mg IV Q6
  6. ^Dialysis if anuric, RF, or CHF

^if Rxs 1-3 unsuccsessful

See Also

Hem/Onc: Hypercalcemia of Malignancy

Source

2/12/06 DONALDSON (adapted from Tintinalli, Mistry)

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