Hello all. After a week of no blogging (I was on stay-cation), it was great to discuss an interesting case of a young man with hypercalcemia. We discussed the differential diagnosis and management of hypercalcemia, with a focus on sarcoidosis.
Key pearls from today:
- severe hypercalcemia (ie >3) is rarely due to hyperparathyroidism alone
- FLUIDS are key; there is no evidence to support the use of furosemide in the management of hypercalcemia. See here for a narrative review on the subject (narrative because there are no trials!). Bisphosphonates are also supported by the evidence, with caution needed in renal impairment.
- In the absence of renal failure, the PO4 level can provide a quick clue to etiology: In vitamin-D related hyperCa (ie granulomatous disease, vit D intoxication), PO4 will be increased as it is reabsorbed more avidly. A high PO4 makes hyperPTH or PTH-related protein less likely as PTH/PTHrp typically cause decreased PO4 reabsorption in the kidney.
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