Hypercalcemia

50 yo male w/ Child C cirrhosis, bedbound > 1mos, Ca on admission 11.1, now w/ acute rise to 14.6 and AMS. PTH 15.

Causes:

PTH-dependent: Primary hyperparathyroidism due to parathyroid adenoma or hyperplasia.

PTH-independent: malignancy (MM, Breast Ca., Lung Ca.) Granulomatous Dz (Sarcoidosis, TB), thyrotoxicosis, AI, pheochromocytoma,  medications(esp. thiazides and lithium), Vit D intoxication, milk-alkali syndrome,FHH, immobilization, advanced liver dz, post-renal transplant, HIV/AIDS

Treatment:

Hydration

Bisphosphonates (inhibit osteoclast activity)

Cinacalcet(binds to calcium-sensing receptor on Chief Cells in parathyroid gland and increases sensitivity to extracellular calcium)

Conclusion:

Pt. w/ PTH dependent hypercalcemia +/- PTH-independent causes such as advanced liver dz., immobilization.

Further w/u P

Hydration started, consider treatment w/ bisphosphonates/cinacalcet in future.

Hypercalcemia

50 year old female with liver cirrhosis with altered mental status.
The patient's calcium is 14 and has an elevated ionized calcium.
The patient's PTH is 15.
What are the causes and how do you treat this patients?