Hypercalcemia

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)

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)

-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)