Hypercalcemia

Hypercalcemia

  • Signs/symptoms: lethargy, confusion, coma, muscle weakness, myalgias, arthralgias, polyuria, kidney stone development, ECF depletion, renal failure, metabolic alkalosis, EKG changes, arrhythmias, HTN, heart failure, constipation, N/V, anorexia, acute pancreatitis, increased risk of digoxin toxicity
  • Causes:  malignant disease, hyperparathyroidism, thyrotoxicosis, TPN, granulomatous diseases, immobilization/multiple fractures, acidosis, milk-alkali syndrome (milk +antacids)
  • Medications that can increase Ca:  thiazide diuretics (HCTZ), estrogens & antiestrogens (tamoxifen), Li, Vit A & D, Ca supplements
  • Trxt:  NS +/- furosemide  (monitor K & Mg carefully), calcitonin, corticosteroids, bisphosphonates, mithramycin, phosphate replacement
    • Patient usually gets dehydrated due to polyuria so use NS until hydrated at which time you add furosemide

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