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Updated: Dec 15 2019

Hypercalcemia

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  • Introduction
    • An increase in serum calcium level
    • Mechanisms and pathophysiology
      • dietary causes
        • calcium ingestion (milk-alkali syndrome)
        • hypervitaminosis D
        • hypervitaminosis A
      • pharmacologic causes
        • thiazides
          • causes increased distal tubule reabsorption of calcium
          • used to treat hypercalciuria
      • malignancy-associated causes
        • Paget's disease
          • typically does not result in hypercalcemia
          • can be come hypercalcemic if patient is immobilized
        • squamous cell cancer of the lung
          • ectopic production of PTH (PTH related peptide - PTHrP)
        • multiple myeloma
          • production of IL-1 activates osteoclast-driven bone resorption
      • sarcoidosis
        • granulomatous macrophages produce 1α-hydroxylase which produces high amounts of 1,25 vitamin D
      • hyperparathyroid
      • genetic causes
        • familial hypocalciuric hypercalcemia
          • defect in calcium sensor of parathyroid gland
            • there is a loss of negative feedback on PTH by hypercalcemia
            • PTH levels are normal to high despite high serum calcium levels
          • urine excretion of calcium is low
            • key feature distinguishing primary hyperparathyroidism from FHH
      • other causes
        • hyperthyroid
        • Addison's disease
        • Zollinger-Ellison syndrome
  • Presentation
    • Symptoms
      • CNS
        • confusion
        • stupor
        • weakness
      • gastrointestinal
        • constipation
        • anorexia
        • nausea
        • vomiting
      • kidney
        • polyuria
        • kidney stones
        • polydipsia
    • Physical exam
      • weakness
      • decreased/absent reflexes
    • EKG
      • shortened QTc interval
  • Treatment
    • Conservative
      • hydration
        • saline diuresis
    • Pharmacologic
      • loop diuretics
      • bisphosphonates
      • mithramycin
      • calcitonin
      • galium nitrate
    • Other
      • dialysis
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