A Family Doctor's Tale - HYPERCALCEMIA

DOC I HAVE HYPERCALCEMIA

Hypercalcemia is defined as high calcium(above 10.4 md per liter) in the blood.

Normal blood Calcium varies from 8.4 to 10.4 mg per liter.

Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal

Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.

Vitamin D increases the intestinal absorption of calcium and phosphate.

Hypercalcemia occurs with high calcium due to:
1.High parathyroid hormones due to parathyoid adenomas

2.Vitamin D excess

3.Various malignancies including myeloma and leukemia.

4.breast tumors and metastases

5.sarcoidosis

Symptoms of Hypercalcemia:
1.weakness

2.lethargy

3.intractable nausea and vomiting

4.dehydration

5.constipation

6.coma

7.cardiac arrthymia

8.calcification of joint or skin

Diagnosis:
1.Plasma calcium and phosphate levels

2.Blood sodium bicarbonate and gases

3.Blood albumin and proteins

4.Joint Xrays in cases of joint calcification

Complications:
1.Calcification of gouty trophi

2.renal stones

3.Cacific tendonitis

4.Myositis ossificans

5.chondrocalcinosis

6.phosphate arthropathy

Treatment:
Acute hypercalcemia is a medical emergency because of its effect on the heart rhythm.
1.Immediate treatment of intravenous isotonic saline and

2.a powerful diuretic such as frusemide to induce excess calcium to pass out through the urine

3.Phosphate intravenously or orally can also be effective to reduce the calcium from the blood although it may cause diarrhea

4.Corticosteroids are also effective in reducing calcium blood levels.

5.Treat underlying cause.

6.Frequent monitoring of progress by blood studies

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea