Acute Hypercalcemia

Most Common Causes:

1-Endocrine:

➧ Hyperparathyroidism

➧ MEN

➧ PTH-related peptide (PTHrP) by solid tumors

2-Neoplastic:

➧ Ca with bone metastases

➧ Myeloma

3-Granulomatous:

➧ Sarcoidosis 

➧ Tuberculosis

Clinical picture:

➧ History of polyuria and polydipsia 

➧ Dehydration

➧ Bone pain

➧ Confusion

➧ Anorexia 

➧ Constipation

ECG Changes: (Figure 1)

Figure 1: ECG changes in Acute Hypercalcemia

Workup:

S – Ca (High) ➔ PTH (High) ➜ Primary Hyperparathyroidism

➔ PTH (Low) ➜ Malignancy or other cause

S – Ca > 3.0 is 90% of the time of malignant origin

Management of Hypercalcemia:

Volume repletion and diuresis:

➧ NaCl 0.9%: 4 L in first 24 h.

➧ Loop diuretics: Furosemide: 40-80 mg/2 h. IV

-Natriuresis promotes calcium excretion.

Bisphosphonates IV: (Pamidronate /Zoledronate)

-Potent inhibitors of bone resorption.

Corticosteroids:

➧ Prednisone: 30-60 mg/d.

➧ Hydrocortisone: 200mg/d. IV

-Impeding growth of lymphoid neoplastic tissue & enhance vit. D actions.

Calcitonin:

-4 units/kg/12 h. IM/SC

-Inhibits bone resorption.

Plicamycin-antineoplastic:

-Inhibits resorption.

Dialysis:

-Patients with renal failure.

Urgent Parathyroidectomy

Read more ☛ Acute Hypocalcemia

Categories: Endocine Emergencies