Hypercalcemia Diagnosis and Management

Teaching video link:
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Hypercalcemia

Hypercalcemia: Serum calcium above 10.5 mg/dL
Common Causes: Primary hyperparathyroidism, malignancy
Symptoms: Often nonspecific, severe cases can lead to confusion, coma, or cardiac arrhythmias

Pathophysiology
Primary Hyperparathyroidism: Excess PTH increases serum calcium
Other Causes: Malignancy, vitamin D intoxication, sarcoidosis
Malignancy-Related Hypercalcemia: Tumor secretion of PTHrP

Clinical Presentation
Mild Cases: Often asymptomatic
Severe Cases: Nausea, vomiting, lethargy, confusion, cardiac arrhythmias
Common Symptoms: Fatigue, weakness, constipation, polyuria, polydipsia

Diagnosis
Serum Calcium: Measure and correct for albumin
Ionized Calcium: More accurate in symptomatic patients
Further Tests: PTH, vitamin D levels, imaging studies
ECG Findings: Shortened QT interval, ST elevation, Osborne waves

Management
Initial Treatment: IV fluids, especially in symptomatic patients
Additional Treatments: Calcitonin, bisphosphonates, glucocorticoids
Severe Cases: Hemodialysis, surgery in primary hyperparathyroidism

Prognosis
Mild Hypercalcemia: Good prognosis with treatment
Severe Hypercalcemia: Life-threatening if untreated