Oncological Emergencies: Hypercalcaemia

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