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Hypercalcemia (Etiology (Drugs (less com.) (thiazide, lithium, estrogens,…
Hypercalcemia
Etiology
Malignancy
(90%)
Excess PTH
primary hyperparathyroidism (90%)
Drugs
(less com.)
thiazide
lithium
estrogens
Vit. D toxicity
calcium ingestion
Granulomatous disease
#
sarcoidosis
TB
lymphoma
Endocrine
adrenal insufficiency
Addison's disease
Signs & symptoms
decrease neuronal conduction
CNS depression
fatigue
weakness
confusion
lethargy
stupor
coma
impedes renal absorption of fluid & electrolyte
dehydation
oliguric renal failure
GIT
anorexia
vomit
constipation
ileus
abdominal pain
chronic hypercalcemia & vol. depletion
renal stones
calcium-induced interstitial nephritis
CVS
hypovolemia
Treatment
restore intravascular vol.
correct electrolyte abnormalities
vol. resuscitation --- isotonic saline
enhance renal calcium elimination
saline diuresis
loop diurectics (avoid thiazide) after restore intravascular vol.
reduce osteoclastic activity (not usually done in ED)
mithramycin & calcitonin
treat primary disorder
Investigation
ECG
shorten QT interval
prolonged PR interval
widen QRS