image by: Atanamir

HWN Suggests

Hypercalcemia in a nutshell

Have seen a few patients with hypercalcemia recently and it has gotten me thinking. It is one of those areas of medicine where the complex endocrine physiology and diseases can seem a bit overwhelming. When we approach it in a practical sense it is much simpler than the head-spinning Med school lectures left us believing! So lets break it down...

Pick up any medical textbook and you will find a long list of causes of hypercalcemia (same with pancreatitis). However, in reality the list is pretty simple. There are 2 big causes, one lesser and then daylight until the small print causes.

read full article

Featured

 Challenging the dogma that severe hypercalcemia is life threatening

This study, which the authors claim is the first to specifically investigate the immediate threat posed by severe hypercalcemia, has revealed no evidence that the condition results in immediate life-threatening cardiac arrhythmia or coma. The cause of death among this study cohort could be justifiably attributed to factors other than severe hypercalcemia.

 ED Management of Hypercalcemia of Malignancy

Five to 25% of patients with malignancy will have hypercalcemia, and approximately 1/3 of all patients who present to the ED with hypercalcemia will be related to malignancy. Hypercalcemia of malignancy typically occurs in advanced stages of malignancy.

 EM@3AM: Hyper- and HypoCa

More than 90% of symptomatic hypercalcemia cases are due to hyperparathyroidism or malignancy.

 Pediatric Hypercalcemia

More likely to be of clinical significance in pediatric patients than in adults.

Articles of Interest

Avoid the Pitfalls That Delay Diagnosis & Treatment

Classic symptoms are often treated by specialists who do not necessarily consider primary hyperparathyroid disease as a possible root cause.

Back to Basics: Hypercalcemia

Total calcium >10.5mg/dL, usually asymptomatic when less than 12.

CORE EM: Hypercalcemia

Patients with severe hypercalcemia (> 14 mg/dL) are at risk for severe cardiac dysrhythmias and cardiac collapse. Treatment centers on volume repletion with normal saline with consideration for the addition of loop diuretics AFTER volume reexpansion is complete

Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?

Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur in up to 30% of cancer patients at some point during the disease.

Podcast #292: Hypercalcemia

It is important to order an ionized calcium to quantify the level of hypercalcemia, since calcium binds to albumin.

Rapid Review: Hypercalcemia

Most commonly caused by: Malignancy (most common inpatient cause), Primary hyperparathyroidism (most common outpatient cause).

When the bad gets worse: Oncologic Emergencies

Produced by a variety of disorders, malignancy is by far the most common along with primary hyperparathyroidism. Major range of clinical symptoms and based on serum Ca2+ levels. Malignancy more commonly raises serum levels >13 mg/dL.

Resources

Life in the Fastlane

The main ECG abnormality seen with hypercalcaemia is shortening of the QT interval.

EMCrit

No role for forced diuresis (furosemide plus fluid).

WikEM

Furosemide is NOT routinely recommended.