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Hypercalcemia, Emergency Medicine

Matthew A. Wheatley and Ryan A. Stroder Reviewed 06/2017
 


Basics

Description

  • Severity depends on serum calcium level and rate of increase

  • 0.1–1% of patients on routine screening

  • Most cases mild (<12 mg/dL) and asymptomatic

  • Hypercalcemic crisis, usually >14...

Diagnosis

Signs and Symptoms

History

  • Neurologic:

    • Headache

    • Fatigue, lethargy

    • Weakness

    • Difficulty concentrating

    • Confusion

    • Depression, paranoia

  • Renal:

    • Polyuria, polydipsia

    • Complaints related to oliguric renal failu...

Treatment

Pre-Hospital

Routine stabilization techniques 

Initial Stabilization/Therapy

  • ABCs, IV access, oxygen, cardiac monitor

  • 0.9% NS 1 L bolus (20 mL/kg) for hypotension or severe dehydration

  • Naloxone, ...

Follow-Up

Disposition

Admission Criteria

  • Corrected total calcium level >13 mg/dL

  • Signs or symptoms attributed to hypercalcemia, especially EKG changes

  • Monitored bed or ICU for corrected level >14 or...

Pearls and Pitfalls

  • Make decisions based on symptoms or corrected Ca levels

  • All patients with serum Ca >14 mg/dL require treatment regardless of symptoms

  • Pay careful attention to EKG changes

  • Careful m...

Additional Reading

  • Ariyan  CE, Sosa  JA. Assessment and management of patients with abnormal calcium. Crit Care Med.  2004;32(suppl 4):S146–S154.

  • Inzucchi  SE. Management of hypercalcemia. Diagnos...

Codes

ICD9

  • 275.42 Hypercalcemia

  • 275.49 Other disorders of calcium metabolism

  • 588.89 Other specified disorders resulting from impaired renal function

  • 592.0 Calculus of kidney

ICD10

  • E83.52 Hypercalcemia

  • E83.59...

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