Health Dictionary
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Hypercalcemia (Assessment and Plan)
Introduction
Author: William J Gibson MD, PhD
#Hypercalcemia
Corrected Ca = Serum Ca + 0.8 x (4-Alb)
Diagnostic approach:
Initial labs: Get serum PTH, ionized calcium, 1,25(OH)D, 25(OH)D.
High PTH: Primary hPTH, FHH (check 24H urine Ca/Cr ratio), tertiary hPTH
Low PTH:
PTHrP-driven: Malignancy (lung, breast, RCC)
High 1,25(OH)D: Granulomatous disease (TB, sarcoid), lymphoma
High 25(OH)D: Vit D toxicity
Normal labs: Multiple myeloma, milk-alkali, hypothyroidism, adrenal insufficiency, pheo, thiazides, lithium
Treatment:
– If mild: conservative tx, encourage PO, oral phos repletion
– IV fluids (NS bolus, drip), pts typically dehydrated
– Calcitonin 4-8U/kg SC BID for 48hrs
– Bisphosphonates (zoledronate preferred vs pamidronate except in MM), caution if CKD
– Consider Denosumab (anti-RANKL) if refractory to bisphos
– Primary hyperPTH: surg curative. If poor candidate, cinacalcet, bisphos, tamox.
– If life-threatening: HD