{"id":1454,"date":"2017-07-19T08:54:39","date_gmt":"2017-07-19T08:54:39","guid":{"rendered":"http:\/\/papergp.com\/index.php\/data-interpretation\/fbc-2\/calcium\/hypercalcaemia\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"hypercalcaemia","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/calcium\/hypercalcaemia\/","title":{"rendered":"Hypercalcaemia"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Data Gathering<\/h4>\n<ul>\n<li><strong>Assess severity<\/strong>\n<ul>\n<li>2.60 &#8211; 3.00 &#8211; not usually a medical emergency<\/li>\n<li>3.00 &#8211; 3.50 &#8211; possible medical emergency<\/li>\n<li>&gt; 3.50 &#8211; usually a medical emergency<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>nb: other factors are important e.g. symptoms, renal function, speed of onset<\/p>\n<ul>\n<li><strong>When to suspect hypercalcaemia<\/strong>\n<ul>\n<li>Symptoms\n<ul>\n<li>Bones &#8211; bone pain<\/li>\n<li>Stones &#8211; renal stones<\/li>\n<li>Abdominal groans &#8211; constipation, n&amp;v<\/li>\n<li>Psychiatric moans &#8211; depression, lethargy, confusion, psychosis<\/li>\n<li>Others &#8211; polyuria, polydipsia (these are most specific)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><strong>Causes<\/strong>\n<ul>\n<li>Primary hyperparathyroidism<\/li>\n<li>Renal disease &#8211; tertiary hyperparathyroidism, treatment with vitamin D analogues<\/li>\n<li>Malignancy &#8211; primary solid tumour, secondary in bone, haematological<\/li>\n<li>Others &#8211; hyperthyroidism, sarcoidosis, vitamin D toxicity, medications (lithium, thiazide)<\/li>\n<\/ul>\n<\/li>\n<li><strong>Measure PTH<\/strong>\n<ul>\n<li>&lt;15 ng\/L\n<ul>\n<li>Non PTH dependent hypercalcaemia &#8211; malignancy, hyperthyroidism, vitamin D toxicity, sarcoid<\/li>\n<\/ul>\n<\/li>\n<li>15-30 ng\/L\n<ul>\n<li>Equivocal &#8211; PTH is neither clearly suppressed nor in the range expected with primary hyperparathyroidism &#8211; repeat<\/li>\n<\/ul>\n<\/li>\n<li>&gt;30 ng\/L\n<ul>\n<li>Causes\n<ul>\n<li>Primary hyperparathyroidism (most common cause)<\/li>\n<li>Familial &#8211; MEN I, IIa, FHH<\/li>\n<li>Tertiary hyperparathyroidism (advanced kidney disease)<\/li>\n<li>Medications &#8211; Lithium<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical Management<\/h4>\n<ul>\n<li>PTH-dependent hypercalcaemia\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+Es, LFTS, TFTs, Bone profile, PTH, Vitamin D<\/li>\n<li>ECG<\/li>\n<li>CXR<\/li>\n<li>DEXA (if not done in past 3 years and patient not known to have osteoporosis)<\/li>\n<li>Refer\n<ul>\n<li>Endocrine &#8211; confirmation of diagnosis, rule out familial, assessment for surgery<\/li>\n<li>Renal &#8211; if kidney disease<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Others\n<ul>\n<li>Stop excessive dietary calcium<\/li>\n<li>Stop thiazides<\/li>\n<li>Lithium &#8211; discuss with endocrine\/psychiatry before stopping<\/li>\n<\/ul>\n<\/li>\n<li>Non PTH-dependent hypercalcaemia\n<ul>\n<li>If known cancer &#8211; refer to relevant hospital team<\/li>\n<li>If underlying cancer not known, referral depends on history and other findings<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Data Gathering Assess severity 2.60 &#8211; 3.00 &#8211; not usually a medical emergency 3.00 &#8211; 3.50 &#8211; possible medical emergency &gt; 3.50 &#8211; usually a medical emergency nb: other factors are important e.g. symptoms, renal function, speed of onset When to suspect hypercalcaemia Symptoms Bones &#8211; bone pain Stones &#8211; renal stones Abdominal groans &#8211; &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/calcium\/hypercalcaemia\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Hypercalcaemia<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1452,"menu_order":26,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1454","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1454","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=1454"}],"version-history":[{"count":5,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1454\/revisions"}],"predecessor-version":[{"id":2088,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1454\/revisions\/2088"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1452"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=1454"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}