Hypercalcemia

Hypercalcemia

Written by Dr Andrew Lam

Corrected Calcium

Corrected Calcium = = 0.8 * (Normal albumin – Patient’s Albumin) + Measured Calcium

Symptoms

Bones – increased risk of osteolysis and fracture

Stones – increased incidence of hypercalcemic renal stones

Abdominal groans – nausea and vomiting, constipation and anorexia

Psychiatric overtones – depression, confusion and in later stages, hallucination and coma

Others – muscle weakness, malaise, hyporeflexia and in some cases, arrhythmias with bradycardia

ECG Findings

Severe Hypercalcemia with Shortened QT and Osborne Wave (V1)

Treatment of Hypercalcemia

Mild (<3.0mmol/L)

Usually asymptomatic or only mildly symptomatic – usually doesn’t require treatment

Avoid dehydration and thiazide diuretics that may worsen hypercalcemia

Moderate (3.0-3.5mmol/L)

If asymptomatic – usually does not require treatment

If symptomatic, management with isotonic saline infusion +/- bisphosphonates or calcitriol may be warranted

Severe (>3.5mmol/L)

Usually requires management with isotonic saline infusion +/- bisphosphonates or calcitriol 

In all cases, make sure to treat the underlying cause of hypercalcemia (i.e. hyperparathyroidism, malignancy, Vit D intoxication) where possible

References:

Burns, E., Buttner, R. (2021). Hypercalcemia. Life in the Fastlane. Retrieved 17th July 2021 from https://litfl.com/hypercalcaemia-ecg-library/

Shane, E. Berenson, J.R. (2021) Treatment of Hypercalcemia. UpToDate. Retrieved 17th July 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/treatment-of-hypercalcemia

Shane, E. (2021) Diagnostic approach to hypercalcemia. UpToDate. Retrieved 17th July 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/diagnostic-approach-to-hypercalcemia