Corrected serum calcium above 2.6 mmol/L; malignancy and primary hyperparathyroidism account for 90% of cases.
Clinical features
- • Stones, bones, abdominal groans, psychic moans
- • Polyuria, dehydration
- • Confusion, coma if >3.5 mmol/L
Investigations
- • Corrected calcium, PTH (key discriminator)
- • PTHrP, myeloma screen, vitamin D, ACE
- • ECG — short QT
- • Imaging for malignancy
Management
- • IV 0.9% saline 3–4 L/24 h
- • Zoledronic acid 4 mg IV once rehydrated (onset 2–4 days)
- • Calcitonin for rapid short-term control
- • Steroids for granulomatous or lymphoma-related
- • Denosumab if bisphosphonate-refractory or renal failure
Clinical pearls
- • High PTH → parathyroid cause; suppressed PTH → malignancy or vitamin D excess
- • Avoid loop diuretics until euvolaemic
Related in WardRound
Educational — verify locally.
