CURRENT Essentials of Critical Care.pdf

Chapter 5 Fluids, Electrolytes, & Acid-Base 53■■■HypercalcemiaEssentials of Diagnosis• Serum calcium [Ca 2 ] 10.5 mg/dL (corrected for albumin) orelevated ionized calcium• Anorexia, nausea, vomiting, adynamic ileus, constipation, abdominalpain, pancreatitis• Altered mental status with apathy, obtundation, coma, psychosis• Polyuria, polydipsia, nephrocalcinosis, impaired urinary concentratingability• Band keratopathy of eyes• Increased risk of bone fractures• ECG with shortened QT interval; cardiac arrhythmias especiallyin patients on digitalisDifferential Diagnosis• Hyperparathyroidism • Malignancy• Vitamin A or D intoxication • Thiazide diuretics• Milk-alkali syndrome • Thyrotoxicosis• Adrenal insufficiency • Immobilization• Paget disease of bone• Familial hypocalciuric hypercalcemia• Granulomatous diseases: sarcoidosis, tuberculosis, fungal infectionsTreatment• Aggressive fluid resuscitation with normal saline• Once euvolemic, loop diuretics to induce calciuresis; avoid thiazides• Calcitonin useful with life-threatening hypercalcemia in initialphase of therapy due to rapid onset of action but transient effect• Bisphosphonates lower calcium over several days• Glucocorticoids effective in steroid-sensitive malignancy, granulomatousdisease, vitamin D induced hypercalcemia• Hemodialysis• Evaluate for underlying etiology especially malignancy■ PearlThe serum calcium level should be corrected according to the patient’salbumin level based on the following calculation:calcium measured 0.8 (4 albumin).ReferenceFukugawa M et al: Calcium homeostasis and imbalance. Nephron 2002;92:41.[PMID: 12425329]