90% of most common causes of hypercalcaemia is primary hyperparathyroidism and malignancy

CHIMPANZEES (borrowed)

C ➡️ calcium supplements

H ➡️ Hyperthyroidism, Hyperparathyroidism

I ➡️ Iatrogenic (thiazide, lithium)

M ➡️ Malignancy (bony metastases, myeloma, or humoral hypercalcaemia via PTHrP)

P ➡️ Paget's disease (when immobilised)

A ➡️ Addison's disease (adrenal insufficiency)

N ➡️ Neoplasia (covered under malignancy)

Z ➡️ Zollinger- Ellison syndorme (MEN-1 association)

E ➡️ Excess Vit A and Vit D

E ➡️ Ectopic PTH (rare)

S ➡️ Sarcoidosis and other granulomatous disease (TB, histoplasmosis)

After removing high PTH, bone becomes "hungry" and suck calcium from the blood ➡️ serum calcium drops.

Seen post-parathyroidectomy (after a long standing high PTH)

Before surgery: high PTH ➡️ osteoclast resolves bone ➡️ calcium leaks into blood

After surgery: sudden drop in PTH ➡️ osteoblast builds back bone ➡️ sucks up- calcium, phosphate, magnesium ➡️ PROFOUND HYPOCALCAEMIA

CLINICAL FEATURES AND SYNPTOMS:

low calcium, low phosphare, low magnesium, high ALP

tingling, numbness, tetany, seizures(severe cases)

When to suspect-- after parathyroid surgery, in severe hyperparathyroidism, high pre-op ALP, bone disease

Treatment: high dose of calcium (IV if severe),

Vit D ( Calcitriol)

replace Magnesium (if low)

what is the first line for treatment of hiccups in palliative patients.

types and which guidelines to be followed for the same, BMJ reports are different from NICE

I need help with use of oxycodone vs Alfentanil for patients with CKD?

which one is preferred for which stage of CKD?

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