hypercalcaemia
etiology
high PTH (inappropriately)
- primary hyperparathyroidism
low PTH
| copied shamelessly from Deranged Physiology | |
|---|---|
| With raised PTH-related-protein: - carcinoma of lung - oesophageal carcinoma - head and neck SCC - renal cell carcinoma - Breast cancer - Ovarian cancer - Bladder cancer With raised 25-hydroxyvitamin D levels - Vitamin D oversupplementation - Lymphoma With lytic bone lesions, and normal PTHrp/Vit D - Multiple myeloma - Breast cancer - Hematological malignancies - Phaeochromocytoma - VIP-secreting gastric adenoma |
With raised 1,25-dihydroxyvitamin D levels - Extra-renal production of Vit D: - Sarcoidosis - HIV - Tuberculosis - Histoplasmosis - Coccidioidomycosis - Leprosy - Could still be primary hyperparathyroidism Random miscellaneous causes without malignancy or Vit D disturbances - Thiazides - Lithium - Oestrogens and HRT - Androgens - Theophylline and aminophylline - Vitamin A - Aluminum toxicity - Total parenteral nutrition (TPN) - Immobilization (eg. spinal injury) - Chronic renal failure - Milk alkali syndrome - Rhabdomyolysis |
signs + symptoms
classic features
- constipation
- polyuria
- Nephrogenic diabetes insipidus
- Nephrolithiasis
- Type 1 (distal) renal tubular acidosis
- renal failure
- pancreatitis
ECG changes
- Shortened QT interval
- Osborn waves, notches in the end of the QRS complex (similar to those seen in hypothermia)
- Weird-looking QRS complexes
- VF
investigations
- Alkaline phosphatase
- Serum PTH level
- CK
- Parathyroid hormone related peptide (PTHrp)
- Serum Vitamin D metabolite levels
- CXR - or better yet, CT chest - to look for obvious malignancy and granulomatous disease.
management
- Fluid resuscitation
- Bisphosphonates - pamidronate