HYPERCALCEMIA

Question 1

What are the causes?

Answer 1

“CHIMPANZEES”:
Calcium supplementation IV
Hyperparathyroidism (1	degree/3	degrees)
hyperthyroidism
Immobility/Iatrogenic (thiazide
diuretics)
Mets/Milk alkali syndrome
Paget’s disease (bone)
Addison’s disease/Acromegaly
Neoplasm (colon, lung, breast,
prostate, multiple myeloma)
Zollinger-Ellison syndrome (as part of
MEN I)
Excessive vitamin D
Excessive vitamin A
Sarcoid

Question 2

What are the signs/

symptoms?

Answer 2

Hypercalcemia—“Stones, bones, abdominal
groans, and psychiatric overtones”
Polydipsia, polyuria, constipation

Question 3

What are the ECG findings?

Answer 3

Short QT interval, prolonged PR interval

Question 4

What is the acute treatment

of hypercalcemic crisis?

Answer 4

Volume expansion with NS, diuresis with

furosemide (not thiazides)

Question 5

What are other options for

lowering Ca+ level?

Answer 5

Steroids, calcitonin, bisphosphonates
(pamidronate, etc.), mithramycin, dialysis
(last resort)