Calcium correction:

• Corrected Calcium = (0.8 (normal albumin – patient’s albumin)) + Ca2+
• Check an ionized (free) calcium

Interpreting the degree of hypercalcemia:

• Normal (8-10 mg/dL)
• Mild hypercalcemia (10-12 mg/dL)
• Moderate hypercalcemia (12-14 mg/dL)
• Hypercalcemic crisis (>14 mg/dL)

Remember the clinical manifestations of hypercalcemia: “stones, bones, abdominal groans, thrones, and psychiatric overtones”

ECG in hypercalcemia:

• the main ECG abnormality with hypercalcemia is shortening of the QT interval
• in severe hypercalcemia, Osborn waves (J waves) may be seen

3 Main hormones involved in calcium homeostasis:

Etiologies of Hypercalcemia:

Treatment of Hypercalcemia:

• Any symptomatic patient with a calcium level > 12 mg/dL
• Any patient with calcium level > 14 mg/dL

Treatment options:

• IVF (NS) – enhances filtration/excretion of Ca2+; tailored towards urine output ~ 200 mL/hr
• Loop Diuretics (Furosemide) – inhibits calcium reabsorption in the distal tubule; only use one volume status restored
• Bisphosphonate – inhibits osteoclast action/bone reabsorption; indicated in hypercalcemia of malignancy; avoid in renal failure
• Calcitonin – inhibits bone resorption and promotes Ca2+ excretion; recommended for severe cases after IV hydration
• Glucocorticoids – inhibits vitamin D conversion to calcitriol; used for vitamin D intoxication, hematologic malignancies, and granulomatous disease
• Dialysis – used for cases of resistant, life-threatening hypercalcemia