Hypercalcemia

Age: ‍ years old

Gender: ‍malefemale



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*

‍none

‍fatigue

‍weakness

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍constipation

‍increased thirst

‍increased urination

‍confusion

‍depression

‍bone pain

‍kidney stones



Contributing factors:

‍high-calcium diet

no history of: ‍kidney disease, ‍hyperparathyroidism, ‍cancer, ‍sarcoidosis, ‍tuberculosis

no use of: ‍vitamin D supplements, ‍calcium supplements, ‍lithium, ‍thiazide diuretics, ‍new medications





ASSESSMENT:

‍Hypercalcemia ‍likelysuspectedpossible

DDx: primary hyperparathyroidism, malignancy, lung cancer, breast cancer, multiple myeloma, granulomatous diseases, sarcoidosis, tuberculosis, medication-induced hypercalcemia, thiazide diuretics, lithium, vitamin A, calcium supplements, vitamin D intoxication, thyrotoxicosis, familial hypocalciuric hypercalcemia, adrenal insufficiency, milk-alkali syndrome, prolonged immobilization, renal failure, hyperthyroidism, acromegaly, pheochromocytoma, adrenal cortical carcinoma, dehydration, parenteral nutrition, idiopathic hypercalcemia of infancy





PLAN:

Investigations:

- 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

Treatments:

- ‍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

Further care:

- 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 pain