AM Report 12/20/2016: Hypercalcemia

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)

1

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

2

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:

picture8

Etiologies of Hypercalcemia:

3

Pathophysiology/ Causes Calcium Level PTH Level 1, 25-vitamin D Phosphorous
Primary Hyperparathyroidism Overproduction of PTH, 85% due to single adenoma
Secondary Hyperparathyroidism Overproduction of PTH, commonly due to chronic renal failure ↔ or ↓ ↔ or ↑
Tertiary Hyperparathyroidism Overproduction of PTH, usually by autonomous hypersecretion of PTH ↑↑

4

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

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