Hypercalcemia

HISTORY:

Presents for ‍newknown hypercalcemia



Lab results:

Ca ‍ ‍normal

Phosphate ‍ ‍normal

Albumin ‍ ‍normal

Creatinine ‍ ‍normal

PTH ‍ ‍normal

Vitamin D ‍ ‍normal

Urinalysis ‍ ‍normal



Associated symptoms: *Try using right-click for negatives*

‍no symptoms

‍fatigue

‍weakness

‍nausea

‍vomiting

‍constipation

‍increased thirst

‍increased urination

‍confusion

‍depression

‍bone pain

‍kidney stones



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Hypercalcemia ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍albumin, ‍calcium, ‍phosphate, ‍PTH, ‍Vit D, ‍TSH, ‍cortisol, ‍PRL, ‍β-hCG, ‍serum protein electrophoresis

- Urine: ‍urinalysis, ‍calcium, ‍creatinine, ‍24h calcium

- ECG

- Chest X-ray

- Abdominal ultrasound

- Bone mineral density test

- ‍Bisphosphonates

- ‍Calcitonin

- ‍Cinacalcet

- ‍Phosphate binders

- ‍Vitamin D analogs

- ‍Furosemide

- ‍Steroids

- Stop medications: Thiazides, Lithium, Vitamin A, Vitamin D, Calcium supplements, Antacids, Tamoxifen, Cinacalcet, Excessive use of laxatives

- Encourage hydration

- Dietary counseling: ‍low calcium diet, ‍low vitamin D diet, ‍low phosphate diet

- Repeat calcium in ‍ ‍weeksmonths

- Referral to endocrinologist

- Referral to nephrologist

- Referral to oncologist

- Referral to dietitian

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as bone pain, confusion, or abdominal pai