| ID | 171 |
|---|---|
| Name | HYPERCALCEMIA (Calcium Excess) |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: 1. Bone x-ray. 2. Serum PTH levels are reliable if available. 3. Phosphate clearance study, Hydrocortisone test (40mg orally showly for 10 days), urine calcium have little value. 4. Serum Calcium level increased. 11.5-12mg% produces symptoms. |
| Management | |
| Introduction | |
| History | |
| Etiology | When serum Ca++ level is > 2.62mmol/l, is known as hypercalcemia. Etiology: 1. Malignant involvement of the bone- - Breast cancer - Bronchogenic carcinoma - Multiple myeloma e.t.c. 2. Excess Parathyroid hormone- - Primary and tertiary hyperparathyroidism - Ectopic PTH Syndrome (carcinoma) 3. Excess vit-D effect- - Medication (self administered or iatrogenic) - Increased sensitivity (Sarcoidosis) 4. High bone turnover due to - - Hyperthyroidism - Immobilization e.t.c 5. Associated with renal failure. |
| Clinical Features | Clinical features: Hypercalcemia affects neuromuscular function to produce weakness, and causes polyuria, dehydration, thirst, anorexia, vomiting and constipation, stupor, coma, and azotemia ensue. Alteration in the E. C. G (a short QT interval) and cardiac arrythmia may occur. |
| Preventions | |
| Treatment | Treatment: 1. Treatment consists of contrail of the primary disease. 2. Giving Na+salts intravenously and by adjunctive use of diuretics is the emergency treatment of choice (as excretion of Na+ is accompanied by excretion of Ca++). 3. Sodium in large quantities (70-80 mmol/h), as chloride or sulphate, with or without diuretics (Frusemide) for 12-48 hours may be required. 4. Replacement of water and of K + and Mg ++ is uaually necessary. 5. Calcitonin may be a useful adjunct, (oral 4 MRC unit/kg/day). 6. When hypercalcemia results from sarcoidosis or neoplasm corticosteroids such as prednisolone may be effective. 7. Methramycin is useful if hypercalcemia is the result of neoplasm metastatic to bone. |
| Complications | |
| Prognosis | |
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| Classification | |
| Observation | |
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