Related Cases:
|Case #1 Potassium
|Case #2 Calcium
|Case #3 Calcium
|Case #4 Glucose
|Case #5 Shakes
|Case #6 Weakness
|Case #7 Headache
|Case #8 Weakness
|Case #9 Weakness
|Case #10 Weakness
|Case #11 Weak face
|Case #12 Weak eyes
|Case #13 Shakes
|Case #14 Confusion
|Case #15 Headache
|Case #16 Breathless
|Case #17 Unconscious
|Case #18 Breathless
|Case #19 Weakness
|Case #20 Breathless
A 67 year old lady is seen in ambulatory care. She had blood tests done by her GP as she described some tiredness. Her weight is stable. She has no bowel or bladder or other symptoms. She has no bone pain. Breast screening has been negative. She was found to have calcium of 3.1 mmol/L. She is otherwise well. She has noticed passing more urine and drinking more recently. Clinically she is euvolemic. She is a non-smoker and never smoked. She rarely drinks alcohol. Her past history is only hypertension diagnosed when she was 62. She takes Bendroflumethiazide. Her BP today is 123/78 mmHg. Her blood results are shown below.
Chemistry Value Range Serum Sodium 129 137 - 144 mmol/L
Serum Potassium 4.0 3.5 - 4.9 mmol/L
Serum Chloride 100 95 - 107 mmol/L
Serum Bicarbonate 24 20 - 28 mmol/L
Anion Gap 13 12 - 16 mmol/L
Serum Urea 10.2 2.5 - 7.5 mmol/L
Serum Creatinine 112 60 - 110 micromol/L
Serum corrected Calcium 3.1 2.2 - 2.6 mmol/L
Serum Phosphate 0.7 0.8 - 1.4 mmol/L
Serum Total protein 62 61 - 76 g/L
1. What causes of Hypercalcaemia do you know
The majority are either cancer or primary hyperparathyroidism.
2. What tests would you do and why
What would you do next
Her PTH result comes back and is normal. The other tests are also normal. What is the likely diagnosis
What should be the next step
What are complications of the operation
7. Question
References
MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd |
Case #3 Calcium
-
| About | Anaesthetics and Critical Care | Anatomy | Basic Science | Biochemistry | Cardiology | Cases | Clinical Cases | Crib | Dentistry | Dermatology | Differentials | Drugs | ENT | Electrocardiogram | Embryology | Emergency Medicine | Endocrinology | Ethics | Foundation Doctors | Gastroenterology | General Information | General Practice | Genetics | Geriatric Medicine | Guidelines | Haematology | Hepatology | Immunology | Infectious Disease | Infectious Diseases | Infographic | Investigations | Lists | Microbiology | Miscellaneous | Nephrology | Neuroanatomy | Neurology | Nutrition | OSCE | Obstetrics Gynaecology | Oncology | Ophthalmology | Oral Medicine | Paediatrics | Palliative | Pathology | Pharmacology | Physiology | Procedures | Psychiatry | Radiology | Research | Respiratory | Resuscitation | Rheumatology | Statistics | Stroke | Surgery | Surgical | Toxicology | Trauma and Orthopaedics | Twitter | Urology | Version Jan 2023
Tests
Initial management is rehydration. The calcium level is now 2.8 mmol/L and is generally asymptomatic. I would advise her to ensure she is well hydrated and send her home to await the results through ambulatory care. I would stop any calcium supplements or any drugs that retain calcium. I would bring back in a few days and if calcium is elevated I would give IV Pamidronate or Zoledronate
An elevated Calcium should suppress PTH levels to almost be undetectable. Sometimes the PTH level is very high but even a normal or high normal PTH is abnormal in the context of hypercalcaemia and the diagnosis is likely to be Primary hyperparathyroidism.
She should be referred to endocrinology who can assess and refer to surgeons if they feel that consideration for parathyroidectomy is appropriate.