Tasty Morsels of EM 104 – #FRCEM Hypercalcaemia

2 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

Name some causes of hyper Ca

  • Malignancies
    • myeloma
    • breast
    • renal
    • lung
    • of note 20% of hyperCa with malignancy has no bone mets
    • even in those with bone mets the commonest mechanism of hyper Ca is known as Humoral hypercalcaemia and from the tumour producing “parathyroid hormone related peptide” (ref)
  • hyperparathyroidism
  • paraneoplastic syndromes
  • sarcoid
  • addisson’s
  • dehydration
  • drugs
    • lithium
    • thiazides
  • prolonged cuff time when measuring

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What are the ECG changes?

  • QT shortening (of note in hypocalcaemia the QT gets longer but that’s about the only ECG change
  • J waves (osborne waves) can happen
  • eventually can have ventricular arrhthmia
  • widening of the QRS

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Management

  • fluids/rehydration
  • bisphosphonates
  • calcitonin
  • diruetics (not without its critics)

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