Hypercalcaemia – raised calcium

Serum conc of 2.65 mmol / L or higher- On two occasionsUsual range 2.15 to 2.60 mmol /L ( 8.8 -10.4 mg/dL ) Albumin adjusted levels Can be ◘ Mild 2.65 to 3.00 mmol/L◘ Moderate 3.01 to 3.40 ( can be symptomatic )◘ Severe > 3.40 ADMIT Severity of symptoms also depends on the rate of onset Often incidental finding in asymptomatic patients

90 % of times Primary hyperparathyroidism○ excessive and inappropriate secretion of PTH○ most common cause of ↑ Ca and relatively common disorder○ usual age 50-60 yrs ( but can occur at any age )○ women twice more likely to be affected○ usually mild , asymptomatic and sustained for yrs○ 85 % of time- single parathyroid adenoma is the causeand Malignancy- usually rapidly progressive rise in Ca○ second most common cause○ can be seen in upto 20-30 % of people with cancer○ most common with cancers of ♦ breast ♦ lung ♦ multiple myeloma○ ↑ Cancer is usually advanced if hypercalcemia occurs ie its a late finding

Drug related♦ Thiazide diuretics ♦ Lithium ♦ Vit D ♦ Vit A ♦ Calcium co-prescribed with antacids and Vit D preprations Granulomatous diseases eg sarcoidosis or TB CKD 4 or 5...