Hypercalcaemia

Question 1

Investigations

Answer 1

FBC, UE, LFT
Calcium and phosphate
PTH, Mg, ALP
renal USS/XR-KUB
bone scans, sestimibi scan

Question 2

Acute Treatment

Answer 2

fluids (nephrogenic DI)
magnesium, or loop diuretic
bisphosphonates (bind)
?calcitonin, glucocorticoid, haemodialysis, cinacalcet (activate PTH calcium receptors)

Question 3

PTH actions

Answer 3

bone osteoclasts: increased ALP, Ca, PO
GIT: calcium absorption
Kidney: PO excretion, decreased CaPO crystals

Question 4

Primary hyperPTH

Answer 4

high calcium
low phosphate
high/normal PTH
high ALP

Question 5

Malignancy (myeloma, mets, PTHrP)

Answer 5

high calcium
low phosphate
low PTH
ALP: high (mets,PTHrP) or normal (myeloma)

Question 6

hyperPTH

Answer 6

primary: high Ca, low PO, high PTH
secondary (KF): low Ca, low PO, high PTH
tertiary (late KF): high Ca, high PO, high PTH