90% of hypercalcaemia is due to either malignancy or hyperparathyroid.
Severity: Adjusted Calcium (Ca)
- Severe: >3.5mmol/l – URGENT treatment (risk of dysrhythmia)
- Moderate: 3.0-3.5mmol/l – PROMPT treatment (maybe well tolerated if chromic)
- Mild: <3.0mmol/l – doesn’t require urgent treatment and often asymptomatic
Signs/Symptoms
- Brain: Mood change, Reduced GCS
- CVS: Dysrhythmias, Hypertension
- GIT: Anorexia, Vomiting, Constipation, Pancreatitis, Peptic ulcer
- Renal: Thirst, Renal impairment, Renal Stones
- MSK: Muscle weakness
ECG Changes
- QT short
- PR prolonged > AV block
- Wide QRS
Treatment
- 0.9% NaCl – may need 4-6l in 24hrs, requires close monitoring
- Consider Zoledronic acid or Pamidronate – if fluid does not work
