What Causes Hypercalcemia?

Discussion Calcium homeostasis is regulated by mechanisms involving the absorption from the gastrointestinal tract, bone deposition and resorption, and renal excretion. To review Vitamin D homeostasis click here. Serum calcium is found in three forms: free (47%), protein bound (43%) and diffusable calcium complexes (10%). The protein binding proteins are albumin (80%) and globulin (20%). The free calcium is the most important biologically. Acidosis also increases free calcium and alkalosis decreases free calcium. Problems associated with hypercalcemia include nausea, emesis, abdominal pain, constipation, polyuria, dehydration, mental status changes and coma. Learning Point The differential diagnosis of hypercalcemia includes: Hyperparathyroidism Primary Familial isolated Familial hypercalciuria hypercalcemia MEN I and II Vitamin D excess Chronic granulomatous disorders Drugs Catecholamines Lithium Teriparatide Theophylline Thiazides Vitamin A excess Malignancies Ectopic PTH-producing tumors Pheochromocytoma Other Acromegaly Aluminum excess Adrenal insufficiency Hypophosphatemia Hyperthyroidism Immobilization Idiopathic infantile hypercalcemia Milk alkali syndrome Parenteral nutrition Renal failure Williams syndrome Questions for Further Discussion 1. What are treatments for hypercalcemia? 2. What is included in the differential diagnosis of hypocalcemia? Related Cases Disease: Calcium | Fluid and Electrolyte Balance Symptom/Presentation: Abnormal Laboratory Test S...
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