HYPERCALCEMIA  = ionized Ca >2.7mEq/L

Etiology:

  1. PTH*
     
  2. Addisons
     
  3. MM (multiple myeloma)*
     
  4. Paget's
     
  5. Sarcoidosis (or other granulamatous disease)
     
  6. Cancer* (Lungs, MM, Breast)
     
  7. Milk alkali syndrome
     
  8. Immobilization*
     
  9. > vit D
     
  10. Thiazides*

Some authors recommend mnemonic Pam P. Schmidt
 The ones that have * are most common.

S & S :

  1. GI: N/V, pancreatitis, constipation, PUD
     
  2. CV: elevated BP, < QT, wide TW, coving of ST
     
  3. CNS: confusion, depression, apathy, psychosis
     
  4. GU: stones, renal failure, polyuria/nocturia
     
  5. MUSCULAR: bone pain, fractures, weakness,

DX :

  1. The common mnemonic that summarizes all the above = stones (kidney),
    bones     (osteolysis),  psychic moans and abdominal groans
    (PUD, pancreatitis).
     
  2. EKG changes (see above).
     
  3. LABS
     
  4. Presence of  risk factors present in etiology

Treatment:

  1. IVF with NS
     
  2. Furosemide (promotes excretion) = 20-100mg IV
     
  3. Bisphosphonates (inhibit bone resorption): Pomidronate 60-90 in 1 liter NS over 24 hrs. Serum Ca and Cr. should be monitored q 12-24 hrs.
     
  4. Calcitonin: inhibits bone resorption and promotes renal Ca excretion. The dose is
    4-8 IU/Kg IM or SQ q6-12 hrs. Serum Ca may fall by 1-3 mg/dl in a matter of hours.
    Has very low toxicity and is safe in renal failure
     
  5. Mithramycin 25mcg/kg. Used in CA related hypercalcemia. Due to its toxicity it must be used only in malignant hypercalcemia. CBC, PT/PTT, Cr, LFTs must be closely
    monitored
     
  6. Glucocorticoid = Hydrocortisone 3mg/kg/day. Inhibits cytokine release and inhibits
    GI  Ca  absorption. Used in sarcoidosis, > vitD, MM, and hematologic malignancies..
    Less efective in hyperCa due to solid CA.
     
  7. Note: As compare to Hypocalcemia where QT prolongation occurs and pt is
    prone to develop V. Tach, in Hypercalcemia QT is shortened and fatal arrhythmias
    do not occur