Calcium.

The normal range for serum calcium is 2.25-2.5 mmol/L.

However, in hypercalcaemia, just over half the circulating calcium is protein bound and therefore the level of circulating protein, principally albumin, must also be taken into consideration in making this measurement

Calculate corrected balance.

For each 4g under 40g of albumin add 0.1mmol to Ca++.

Correction calculator

PTH.

  • Increase Ca++ and reduces PO4—in blood.

Vit. D.

  • Increases both by allowing GIT absorption.

Calcitonin.

  • Reduces both by putting them into bone.


Hypercalcaemia.

Admit > 3.0 mmol/l.

Hypercalcaemia is an uncommon problem. Primary hyperparathyroidism is the most common cause. It affects mainly postmenopausal women

Cancer until proven otherwise?

Symptoms.

  • “Bones, stones, abdominal moans and psychiatric groans”.
  • Nausea,Vomiting.
  • Constipation
  • Anorexia , weight loss.
  • TATT
  • weak
  • Polyuria and dipsia.
  • Low BP.
  • Calculi
  • Hyperreflexia

Causes.

Primary hyperparathyroidism and malignancy are responsible for greater than 90% of all cases.

  • Bone mets.
  • HyperPTH.
  • Sarcoid, TB.
  • Hyperthyroidism
  • Dehydration (with thiazide diuretics).

Check calcium, calcitonin,albumin, Vit D, ALP  and PO--.

In the presence of a raised corrected calcium.

  •     A raised albumin level in the presence of a raised urea indicates dehydration.
  •     A raised albumin level in the presence of a normal urea suggests a cuffed specimen.
  •     A normal alkaline phosphatase is indicative of myeloma (raised plasma protein), calcium-alkali syndrome (formerly milk-alkali syndrome), thyrotoxicosis or sarcoidosis.
  •     A raised alkaline phosphatase suggests bony metastases, sarcoidosis or thyrotoxicosis.
  •     A raised calcitonin level is suggestive of B-cell lymphoma.

 

Treatment.

  • Admit!
  • As per cause.
  • Mets: - Bisphosphonates. Denusomab.
  • Hydration.
  • Steroids.
  • Frusemide.
  • Dialysis.
  • Calcitonin.Cincanalet.

Hypocalcaemia.

<2.0mmol/l.

Symptoms.

  • Chvostek sign at face.
  • Perioral paraesthesia.
  • Cramp / spasm.
  • Trousseau’s sign of carpopedal spasm (BP cuff).
  • Increased reflexes.
  • QT changes.
  • Depression

Causes.

  • Post PTH surgery.
  • No Vit D (no sunlight or CRF).
  • Osteomalacia (all Ca++ sequestered for bone).
  • Pancreatitis.
  • Loop diuretic.

Treatment.

  • Vit D.
  • Replacement