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20-September-2008 09:55:48 - Hypercalcaemia Redirected from Hypercalcemia Hypercalcaemia Classification and external resources Calcium ICD-10 E83.5 ICD-9 275.42 DiseasesDB 6196 MedlinePlus 000365 eMedicine med/1068 emerg/260 ped/1062 MeSH D006934 Hypercalcaemia in American English Hypercalcemia is an elevated calcium level in the blood. Normal range: 9-10.5 mg/dL or 2.2-2.6 mmol/L. It can be an asymptomatic laboratory finding, but because an elevated calcium level is often indicative of other diseases, a diagnosis should be undertaken if it persists. It can be due to excessive skeletal calcium release, increased intestinal calcium absorption, or decreased renal calcium excretion. Contents 1 Signs and symptoms 2 Causes 3 Treatments 3.1 Initial therapy: fluids and diuretics 3.2 Additional therapy: bisphosphonates and calcitonin 3.3 Other therapies 4 See also Signs and symptoms Hypercalcemia per se can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis or increased urination Bones, stones, groans, and psychiatric overtones is a saying which will help you remember the signs and symptoms of hypercalcemia; if it is chronic it can result in urinary calculi renal stones or bladder stones. Abnormal heart rhythms can result, and EKG findings of a short QT interval and a widened T wave suggest hypercalcemia. Symptoms are more common at high calcium blood values 12.0 mg/dL or 3 mmol/l. Severe hypercalcemia above 15-16 mg/dL or 3.75-4 mmol/l is considered a medical emergency: at these levels, coma and cardiac arrest can result. Causes hyperparathyroidism and malignancy account for ~90% of cases abnormal parathyroid gland function primary hyperparathyroidism solitary parathyroid adenoma primary parathyroid hyperplasia parathyroid carcinoma C75.0 multiple endocrine neoplasia MEN familial isolated hyperparathyroidism Online 'Mendelian Inheritance in Man' OMIM 146200 lithium use familial hypocalciuric hypercalcemia/familial benign hypercalcaemia Online 'Mendelian Inheritance in Man' OMIM 145980, Online 'Mendelian Inheritance in Man' OMIM 145981, Online 'Mendelian Inheritance in Man' OMIM 600740 malignancy solid tumor with metastasis e.g. breast cancer or classically squamous cell carcinoma, which can be PTHrP-mediated solid tumor with humoral mediation of hypercalcemia e.g. lung or kidney cancer, pheochromocytoma hematologic malignancy multiple myeloma, lymphoma, leukemia vitamin-D metabolic disorders hypervitaminosis D vitamin D intoxication elevated 1,25OH2D see calcitriol under Vitamin D levels e.g. sarcoidosis and other granulomatous diseases idiopathic hypercalcemia of infancy Online 'Mendelian Inheritance in Man' OMIM 143880 rebound hypercalcemia after rhabdomyolysis disorders related to high bone-turnover rates hyperthyroidism prolonged immobilization thiazide use vitamin A intoxication Paget's disease of the bone renal failure severe secondary hyperparathyroidism aluminum intoxication milk-alkali syndrome Treatments The goal of therapy is to treat the hypercalcemia first and subsequently effort is directed to treat the underlying cause. Initial therapy: fluids and diuretics hydration, increasing salt intake, and forced diuresis. hydration is needed because many patients are dehydrated due to vomiting or renal defects in concentrating urine. increased salt intake also can increase body fluid volume as well as increasing urine sodium excretion, which further increases urinary calcium excretion In other words, calcium and sodium salt are handled in a similar way by the kidney. Anything that causes increased sodium salt excretion by the kidney will, en passant, cause increased calcium excretion by the kidney after rehydration, a loop diuretic such as furosemide can be given to permit continued large volume intravenous salt and water replacement while minimizing the risk of blood volume overload and pulmonary edema. In addition, loop diuretics tend to depress renal calcium reabsorption thereby helping to lower blood calcium levels can usually decrease serum calcium by 1-3 mg/dL within 24 h caution must be taken to prevent potassium or magnesium depletion Additional therapy: bisphosphonates and calcitonin bisphosphonates are pyrophosphate analogues with high affinity for bone, especially areas of high bone-turnover. they are taken up by osteoclasts and inhibit osteoclastic bone resorption current available drugs include in order of potency: 1st gen etidronate, 2nd gen tiludronate, IV pamidronate, alendronate, risedronate, and 3rd gen zoledronate all patients with cancer-associated hypercalcemia should receive treatment with bisphosphonates since the 'first line' therapy above cannot be continued indefinitely nor is it without risk. Further, even if the 'first line' therapy has been effective, it is a virtual certainty that the hypercalcemia will recur in the patient with hypercalcemia of malignancy. Use of bisphoponates in such circumstances, then, becomes both therapeutic and preventative patients in renal failure and hypercalcemia should have a risk-benefit analysis before being given bisphosphonates, since they are relatively contraindicated in renal failure. Calcitonin blocks bone resorption and also increases urinary calcium excretion by inhibiting renal calcium reabsorption Usually used in life-threatening hypercalcemia along with rehydration, diuresis, and bisphosphonates Helps prevent recurrence of hypercalcemia Dose is 4 Units per kg via subcutaneous or intramuscular route every 12 hours, usually not continued indefinitely Other therapies rarely used, or used in special circumstances plicamycin inhibits bone resorption rarely used gallium nitrate inhibits bone resorption and changes structure of bone crystals rarely used glucocorticoids increase urinary calcium excretion and decrease intestinal calcium absorption no effect in calcium level in normal or 1' hyperparathyroidism effective in hypercalcemia due to osteolytic malignancies multiple myeloma, leukemia, Hodgkin's lymphoma, carcinoma of the breast due to antitumor properties also effective in hypervitaminosis D and sarcoidosis dialysis usually used in severe hypercalcemia complicated by renal failure. Supplemental phosphate should be monitored and added if necessary phosphate therapy can correct the hypophosphatemia in the face of hypercalcemia and lower serum calcium See also Calcium metabolism Dent's Disease Hypocalcaemia Electrolyte disturbance Disorders of calcium metabolism ATC code V03#V03AG Drugs for treatment of hypercalcemia v d e Inborn errors of metal metabolism E83, 275 Cu Wilson's disease - Menkes disease Fe Primary iron overload disorder: Haemochromatosis Juvenile - Aceruloplasminemia - Atransferrinemia - Hemosiderosis Zn Acrodermatitis enteropathica PO43- Hyperphosphatemia - Hypophosphatemia - Hypophosphatasia Mg2+ Hypermagnesemia - Hypomagnesemia Ca2+ Hypercalcaemia - Hypocalcaemia - Pseudohypoparathyroidism - Pseudopseudohypoparathyroidism - Milk-alkali syndrome Burnett's - Calcinosis Calciphylaxis, Calcinosis cutis - Calcification Metastatic calcification, Dystrophic calcification Retrieved from http://en..org/wiki/Hypercalcaemia Categories: Metabolic disorders | Electrolyte disturbances | Calcium | Urinary system | Diseases | Kidney diseases | Urology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français 日本語 Polski Português Svenska This page was last modified on 6 August 2008, at 04:33
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