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Hypercalcaemia - Management
When should I suspect hypercalcaemia?

  • Many people with chronic hypercalcaemia are asymptomatic, particularly when hypercalcaemia is mild.
  • When symptoms of hypercalcaemia are present, they are often non-specific.
  • The extent of symptoms is related to both the severity of the hypercalcaemia and its rate of onset.
  • Clinical features of hypercalcaemia include (the mnemonic 'bones, moans, groans, and stones' may be helpful):
    • Skeletal ('bones')
      • Bone pain (may be seen in people with primary hyperparathyroidism or cancer).
      • Pathological fractures (due to osteoporosis in primary hyperparathyroidism).
    • Neuromuscular ('moans')
      • Fatigue, muscle weakness.
      • Increased pain (in people with cancer).
      • Impaired concentration and memory.
      • Depression.
      • Drowsiness (common), delirium, seizures, coma.
      • Neurological signs (for example upper motor neurone deficits and ataxia).
    • Gastrointestinal (abdominal 'groans')
      • Nausea, vomiting, anorexia, weight loss.
      • Constipation, abdominal pain.
      • Peptic ulcer, pancreatitis (both rare).
    • Renal ('stones')
      • Renal colic due to kidney stones (nephrolithiasis). This is rare when hypercalcaemia is due to cancer, but is seen in some people with primary hyperparathyroidism.
      • Polyuria, polydipsia, and dehydration (due to nephrogenic diabetes insipidus).
      • Renal impairment (due to nephrocalcinosis).
    • Cardiovascular
      • Hypertension.
      • Shortened QT interval on electrocardiogram (ECG).
      • Potentiation of digitalis action or toxicity.
      • Cardiac arrhythmias (rare).
    • Other
      • Itching.
      • Keratitis, conjunctivitis, and corneal calcification.

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