RENAL AND ELECTROLYTE
HYPERCALCAEMIA
PromptDifferentials for hypercalcaemia
ResponseMalignancy
Hyperparathyroidism (primary or tertiary)
Adrenal insufficiency
Thyrotoxicosis
Drugs (Thiazide)
Granulomatous disease (Sarcoid, TB, etc)
Milk Alkali syndrome
Hypervitaminosis (A or D)
Immobility
Hyperparathyroidism (primary or tertiary)
Adrenal insufficiency
Thyrotoxicosis
Drugs (Thiazide)
Granulomatous disease (Sarcoid, TB, etc)
Milk Alkali syndrome
Hypervitaminosis (A or D)
Immobility
PromptThe Goodest boy ever. Jack. He got pamidronate for his hypercalcaemia of malignancy. Look after mum for me mate!
Response
PromptSymptoms of hypercalcaemia
ResponseBones, stones, groans and psychiatric overtones
MSK (Bones) - muscle weakness, bone pain
Renal (Stones) - polyuria, stone related symptoms
GI upset (Groans) - N/V, Anorexia, constipation, abdominal pain
Neuro (Psychiatric overtones) - Hypotonia, lethargy, confusion (Coma)
MSK (Bones) - muscle weakness, bone pain
Renal (Stones) - polyuria, stone related symptoms
GI upset (Groans) - N/V, Anorexia, constipation, abdominal pain
Neuro (Psychiatric overtones) - Hypotonia, lethargy, confusion (Coma)
PromptECG changes in hypercalcaemia
ResponseQT shortening
Osborn waves
ST elevation
VT/VF
Osborn waves
ST elevation
VT/VF
PromptTreatments to correct hypercalcaemia
ResponseIV fluids (promotes diuresis/renal excretion of calcium)
N/S to maintain urine output >30 mL/h
Bisphosphonate - Pamidronate 90mg - inhibit osteoclast, promobe osteoblast (ca into bones)
Calcitonin 4 IU/kg - inhibits osteoclast activity (CalciTONIN it down)
IV hydrocortisone 100 mg - inhibits vitamin D effects, inhibits osteoclast (Vit D toxicity/haem/malignancy only)
Loop diuretics - decreased reabsorption of Ca at loop of henle
Withhold meds causing hypercalcaemia (eg: thiazide diuretics)
Last resort - Hemodialysis (Must be well justified as other treatments refractory)
Phosphate as calcium binding agent
N/S to maintain urine output >30 mL/h
Bisphosphonate - Pamidronate 90mg - inhibit osteoclast, promobe osteoblast (ca into bones)
Calcitonin 4 IU/kg - inhibits osteoclast activity (CalciTONIN it down)
IV hydrocortisone 100 mg - inhibits vitamin D effects, inhibits osteoclast (Vit D toxicity/haem/malignancy only)
Loop diuretics - decreased reabsorption of Ca at loop of henle
Withhold meds causing hypercalcaemia (eg: thiazide diuretics)
Last resort - Hemodialysis (Must be well justified as other treatments refractory)
Phosphate as calcium binding agent