Hypercalcemia

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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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