Hypercalcaemia

Question 1

systems review

Answer 1

general - lethargy, anorexia

GI - N/V, constipation

Uro - polydipsia + polyuria

CNS - confusion, fits, coma

cancer - recent weight loss, anorexia

exclude fever + obvious infectious cause - neutropenic sepsis

Question 2

PMH

Answer 2

known cancer - type (esp myeloma, breast, lung), date DDx, stage (>20% advanced cancer), treatment (inc SEs)

mood

Question 3

specific meds taken

Answer 3

thiazides

lithium

Question 4

investigations

Answer 4

corrected serum Ca (<=2.65)

U&Es

PTH, bone scan

Question 5

management

Answer 5

aggressive rehydration - 4-6L 0.9% NaCl in 24hrs

IV bisphosphonate = 4mg zoledronic acid over 15 mins

(2nd line: prednisolone, calcitonin)