Hypercalcaemia management in a district general hospital

Results and discussion

Of the 50 patients included in the study, 17 were male with a mean age of 76.1 years. The majority of patients (n=43; 84%) had mild hypercalcaemia (SCa 2.67–2.9 mmol/L); moderate hypercalcaemia (SCa 3.0–3.4 mmol/L) was found in five patients (10%) and severe hypercalcaemia (SCa ≥3.5 mmol/L) in three patients (6%). Thirty-one patients (62%) demonstrated symptoms of hypercalcaemia. All patients had renal function assessed on admission, phosphate was measured in 98%, parathyroid hormone (PTH) in 19 (38%) patients and vitamin D in 32%. Electrocardiography (ECG) was done in 24%, and one patient had ECG changes. Of the patients who had PTH measured, 52% had high PTH levels, 31% had low PTH and 15% had normal PTH levels. Of those with high/normal PTH, 76% were referred to an endocrinologist. 16% of patients had known malignancy. 6% of patients with low PTH had malignancy. Of the patients with malignancy, PTH and vitamin D were not done in 12%. Management varied within the group: 14% of patients received intravenous fluids, bisphosphonates were given to 8%, steroids to 8%, and 2% received dialysis. 74% had repeat adjusted SCa measured after 24 hours. No patient had 24-hour urine calcium. Management of hypercalcaemia was appropriate in 60% of patients. Only 12% had follow-up with endocrinology.