endocrine and metabolic disorders
Hypercalcemia
Key Points
The most common causes of hypercalcemia are hyperparathyroidism and cancer. Clinical features include polyuria, constipation, anorexia, and hypercalciuria with renal stones; patients with high calcium concentrations may have muscle weakness, confusion, and coma. Do chest x-ray; measure electrolytes, bloodureanitrogen, creatinine, ionized calcium, phosphate,parathyroid hormone, 25(OH)D, and alkaline phosphatase, and do serum protein immunoelectrophoresis. In addition to treating the cause, treat mild hypercalcemia (serum calcium<11.5 mg/dL [<2.9 mmol/L]) with oral phosphate or isotonic saline plus a loop diuretic. For moderate hypercalcemia (serum calcium>11.5 mg/dL [<2.9 mmol/L] and<18 mg/dL [<4.5 mmol/L]), add a bisphosphonate, corticosteroids, and sometimescalcitonin. For severe hypercalcemia, hemodialysis may be needed. 