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Hypercalcaemic crisis

From Surgopaedia

HIHC - hyperparathyroidism-induced hypercalcaemic crisis - a rare, potentially life-threatening condition

Aetiology

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  • Hyperparathyroidism
  • Advanced malignancy

Presentation

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  • Defined as a corrected calcium level of 3.49mmol/L or greater with associated organ dysfunction
  • Usually acute onset following intercurrent illness or precipitating event with dehydration
  • Gastrointestinal
    • Anorexia
    • Vomiting
    • Acute pancreatitis
    • Severe PUD
  • Renal
    • Nephrocalcinosis
    • Nephrolithiasis
    • Polyuria/anuria
    • AKI
  • Cardiac
    • Heart block, ventricular tachyarrhythmias
  • CNS
  • 5% have parathyroid cancer

Management

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  • Approach
    • Volume resuscitate and frusemide to increase calciuresis
    • Bisphosphonates first-line - pamidronate or zoledronic acid (4mg infused over 15 minutes) + calcitonin
    • Reduce calcium rapidly
    • Expeditious parathyroidectomy once patient is stable - localise first with SESTAMIBI (more likely to have ectopic mediastinal glands)
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