Hypercalcemia

• Facts:
  Serum calcium > 10.2 mg/d
• History / PE:
  Bones (osteopenia, fractures)
  Stones (kidney stones)
  Abdominal groans (anorexia, constipation )
  Psychiatric overtones (weakness, fatigue, AMS)
• Diagnosis:
  EKG (may show short QT interval)
• Treatment:
  IVF hydration
  Furosemide (lasix)
  Calcitonin, bisphosphonates , glucocorticoids
• Pneumonic:
  "CHIMPANZEES"
  
  C alcium supplementation
  H yperparathryroidism / H yperthyroidism
  I atrogenic (thiazides, parenteral nutrition) / I mmobility
  M ilk-alkali syndrome
  P aget's disease
  A drenal insufficiency / A cromegaly
  N eoplasm ( Hodgkin's lymphoma )
  Z ollinger-Ellison syndrome (eg. MEN )
  E xcess Vitamin A
  E xcess Vitamin D
  S arcoidosis and other granulomatous disease
• Notes:
  Malignancies are one of the MCC of hypercalcemia by
  
  1) production of cytokines (IL-1 and TNF)
  2) PTHrP (breast and lung cancer )
  3) calcitriol
  4) ectopic PTH
• Associated With:
  Acidosis (decreased extracellular pH causes a decrease in the affinity of serum albumin to calcium, thereby decreasing the levels of albumin-bound calcium)