HypercalcaemiaOncological Emergencies
What is
Hypercalcaemia?
Elevated serum calcium level
Normal range: 2.12 – 2.65 mmol/l
CalciumCa
20
40
Most abundant
Electrolyte
Provides hardness and
strength to bone matrix
Initiates muscle
contractions
Maintains normal cellular
permeability
Part of clotting cascade
Causes of
Hypercalcaemia?
Cancer is the 2nd most common cause of Hypercalcaemia after Primary Hyperparathyroidism.
Most common Non-malignant associated Hypercalcaemia
• Hyperparathyroidism• Excess Vit D• Sarcoidosis• Familial metabolic disorders
Most Common malignancy associated hypercalcaemia
• Non small cell lung cancer (sq cell)• Breast cancer• Renal cell cancer• Multiple Myeloma, and lymphoma (up
to 40%)• Head and neck cancers• Cancer metastasising to bone (lung,
breast, kidney,)• Some cancers with bone mets do not
cause hypercalcaemia eg prostate
Symptoms of
Hypercalcaemia?
Only 20%of patients exhibit symptoms
“Stones, bones, abdominal
groans, and psychic
overtones”
Manifestations of Hypercalcaemia
• Bone pain• Renal stones• Abdominal pain and constipation• Confusion / depression• Vomiting• Thirst• Excessive Urination• Loss of appetite and weight• Weakness• Fatigue• Renal Failure• Pancreatitis• Shortening of QT interval• Non specific symptoms “they’re just not right….”
Diagnosis
• Bloods– Elevated serum calcium– Renal Impairment
• ECG– Arrhythmias as calcium is important in cardiac
conduction• X-ray
– Shows specific area of bony pain• Bone scan
Treatment of
Hypercalcaemia?
All patients with hypercalcaemia
should be actively treated
Rehydration
Normal Saline
1 litre over 24 hours with adequate K+ and a mild loop diuretic (furosemide).
Bisphosphonates
Pamidronate is used unless pamidronaterefractory in which case zoledronic acid
Based on urea / calcium level after 24 hours of rehydration
Calcitonin
Only if calcium is extremely raised or patient has significant ECG changes
Nursing implications of
Hypercalcaemia?
Strict Fluid Balance.
Monitor confusion levels.
Observe for non-specific
symptoms.
Conclusion
• Easily treated condition
• Often not picked up on routine bloods
• Need to remember to check calcium if patient had known malignant disease and isn’t themselves