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
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Source: PediatricEducation.org - Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news
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