Hypercalcemia: Difference between revisions
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*90% of cases a/w malignancy or hyperparathyroidism | *90% of cases a/w malignancy or hyperparathyroidism | ||
== | ==Clinical Features== | ||
#Stones (renal calculi) | #Stones (renal calculi) | ||
#Bones (bone destruction) | #Bones (bone destruction) | ||
# | #Abd groans (abd pain, N/V, constipation) | ||
#Psychic moans (lethargy/confusion) | #Psychic moans (lethargy/confusion) | ||
#Polyuria, renal insufficiency | |||
==Diagnosis== | |||
#ECG | |||
##Prolonged PR & QRS | |||
##Shortened QT | |||
##Depressed ST | |||
##Widened T waves | |||
##Bradarrhythmias/ heart block | |||
==Work-Up== | ==Work-Up== | ||
#Calcium | |||
#Phosphate | #Phosphate | ||
#Lipase | #Lipase | ||
| Line 42: | Line 43: | ||
===Indications=== | ===Indications=== | ||
#>14.0 meq/L | #>14.0 meq/L | ||
# | #Symptomatic | ||
# | #Unable to tolerated PO | ||
# | #Abnormal renal function | ||
===Treatment=== | ===Treatment=== | ||
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#Consider dialysis if anuric, ARF or CHF | #Consider dialysis if anuric, ARF or CHF | ||
#Furosemide is NOT recommended | #Furosemide is NOT recommended | ||
==See Also== | ==See Also== | ||
Revision as of 01:14, 23 October 2011
Background
- High >10.5 meq/L (>2.7 ionized)
- High! >12.0 meq/L
- 90% of cases a/w malignancy or hyperparathyroidism
Clinical Features
- Stones (renal calculi)
- Bones (bone destruction)
- Abd groans (abd pain, N/V, constipation)
- Psychic moans (lethargy/confusion)
- Polyuria, renal insufficiency
Diagnosis
- ECG
- Prolonged PR & QRS
- Shortened QT
- Depressed ST
- Widened T waves
- Bradarrhythmias/ heart block
Work-Up
- Calcium
- Phosphate
- Lipase
- UA
- ECG
DDX
- Malignancy
- Hyperparathyroidism
- Lithium
- Thiazides
- Hypothyroidism
- Addison's
- Paget's
- Sarcoid
- Hyperthyroid
- Milk-alkali synd
- Excess vit D
Treatment
Indications
- >14.0 meq/L
- Symptomatic
- Unable to tolerated PO
- Abnormal renal function
Treatment
- Volume repletion (NS 5-10L)
- Goal UOP = 500cc/hr
- Decrease Ca mobilization from bone
- Pamidronate 90mg IV over 24 hours
- Zoledronic acid 4mg IV over 15 minutes
- Calcitonin 4 units/kg SubQ
- Correct hypokalemia/hypomagnesemia
- Consider dialysis if anuric, ARF or CHF
- Furosemide is NOT recommended
See Also
Source
Tintinalli