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Hypercalcaemia - Management
How should I make a diagnosis of hypercalcaemia?
- Take blood to measure serum calcium and serum albumin concentrations.
- Avoid prolonged application of a tourniquet when taking blood to test serum calcium concentration.
- Ensure that the calcium concentration is adjusted (corrected) for the serum albumin concentration. If the laboratory has not already done so (or measured the ionized calcium concentration), use the following calculation:
- Adjusted Ca (mmol/L) = measured Ca (mmol/L) + (0.02 x [40 – Alb (g/L)]), where Ca is serum calcium concentration and Alb is serum albumin concentration.
- This calculation may be inaccurate at extreme albumin concentrations, if the person has paraproteinaemia, or if the person is acidotic. In these circumstances, an ionized calcium concentration should be requested.
- Repeat the test to confirm, unless the person has hypercalcaemia that is severe (adjusted serum calcium concentration greater than 3.40 mmol/L) or symptomatic, when they should be admitted immediately to hospital.
- Diagnose:
- Mild hypercalcaemia — when the adjusted calcium concentration is 2.65–3.00 mmol/L.
- Moderate hypercalcaemia — when the adjusted calcium concentration is 3.01–3.40 mmol/L.
- Severe hypercalcaemia — when the adjusted calcium concentration is greater than 3.40 mmol/L.
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