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Hypercalcemia
Dr Swapnil Pawar
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
Dr Swapnil Pawar July 26, 2021
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