Thank you Dr. Betty Lai for a great case of hypercalcemia on 10.7.15  presenting as altered mental status!

Learning Points:

• The first diagnostic test to workup hypercalcemia should be PTH
• • Hypercalcemia is due to elevation of ionized or free calcium
  • 40-45% of calcium in serum is bound to protein, mainly albumin.
  • Calcium = serum calcium + 0.8 x (normal albumin – patient albumin)
• >90% of cases of hypercalcemia are either from primary hyperparathyroidism vs. malignancy
• Tx: Only for severe hypercalemia (Ca>14) or for symptomatic cases
  • Acutely (quick onset of of action): IVF; Calcitonin; Dialysis; Loop diuretics
  • Long term: Bisphosphonates