Hypercalcemia

Question 1

Hypercalcemia: def

Answer 1

• Se Ca > 2.6mM

.Between 2.6 - 3 mmol/L: light hypercalcemia
. 3 - 3.75 mmol/L: moderate hypercalcemia
. > 3.75 mmol/L: malignant, severe

Question 2

Hypercalcemia: etiologies

Answer 2

• PTH hyper secretion: due to,
  .hyperactive PTH tumor
  . or cancer: lung cancer
  -> with low phosphoremia
• increased Vit D production
  . seen in diseases like TB, sarcoidsois, some lymphomas, excess Vit D intake
  -> normal phosphoremia
• Increased Bone resorption
  . due to either increased bone resorption -> lymphoma, prolonged breast feeding
  . cancerous lesion
  -> normal phosphoremia

Question 3

Hypercalcemia: ECG findings

Answer 3

ECG will correlate with the severity of the hypercalcemia.
“ TA RAQuette PLATe PeRd son RYTHME”

• sinus tachycardia (TAchycardie sinusale)
• shorten QT (RAccourcissement du QT)
• flatten T waves (aPLATissement de l’onde T)
• prolonged PR: 1st degree or 2nd degree AV block (allongement de l’espace PR)
• Ventricular arrhythmia -> V.fib (trouble de RHYTME ventriculaire)

Question 4

Hypercalcemia: what are the reflexes to get in case of hypercalcemia

Answer 4

• 1st -> perform an ECG, it will reflex the severity
• 2nd -> caculate the calcium correction (calcémie corrigée) with the help of the albuminemia.
  The measured calcemia reflects the total calcemia. Including the calcium bounded to the albumin, and the free calcium.
  A decreased in albumin could change the total measure calcemia.
  -> could determine a hypoalbuminemia

Question 5

Hypercalcemia: symptoms

Answer 5

• muscle weakness
• arrhythmias
• cardiac arrest
• kidney stones

Question 6

Hypercalcemia: T

Answer 6

• IV fluids or furosemide

- calcitonin -> promotes calcium excretion and bone remodeling