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What is the definition of hypercalcemia
serum albumin corrected calcium > 3 mmol/L
what are the 4 pathogenesis of hypercalcemia?
1. release of PTH related protein
2. production of bone resorption cytokines
3. osteolytic effects of bone mets
4. tumor mediated calcitriol production
what are the dangerous complications of hypercalcaemia?
1. decreased neuronal conduction (fatigue, confusion, stupor, coma)
2. increased risk of PUD and pancreatitis
3. impairs reabsorption of fluids and electrolytes in the kidney (polydipsia, polyuria, dehydration, electrolyte losses)
4. arrythmias (shortened QTc, prolonged PR, wide QRS), potentiate digoxin
others: renal stones in the future
what is the general management principle for hypercalcemia in a CA patient?
1. fluid replacement (2-5L per day)
2. enhance renal clearance of calcium via frusemide
3. decrease osteoclastic activity via bisphosphonate
4. manage underlying CA
what is the caveat for all cancer patients who suddenly appear to be ill?
suspect hypercalcaemia till proven otherwise
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