REBOOT #281 Hypercalcemia: Calci-fun! with Dr. Carl Pallais
Dec 18, 2023
auto_awesome
Dr. Carl Pallais, an expert in Hypercalcemia, discusses the regulation of calcium in the body and what happens when it goes wrong. Topics covered include the importance of PTH and phosphorus, causes of hypercalcemia, testing for hypercalcemia, symptoms and history, indications for surgery, and management of hypercalcemia.
Hypercalcemia can be caused by various factors such as primary hyperparathyroidism and hypercalcemia malignancy, and its symptoms can range from mild to severe complications.
To diagnose hypercalcemia, repeat calcium levels should be obtained and corrected for albumin levels, while additional tests such as phosphate, 25-hydroxyvitamin D, and parathyroid hormone (PTH) levels should also be considered.
In cases of severe hypercalcemia, it is crucial to act quickly and address it as an emergent situation, using treatment options such as administering fluids, calcitonin, antiresorptive agents, and addressing the underlying cause.
Deep dives
Causes and symptoms of hypercalcemia
Hypercalcemia can be caused by various factors, including primary hyperparathyroidism and hypercalcemia malignancy. Symptoms can range from mild constipation and fatigue to severe complications such as renal failure and pancreatitis.
Diagnostic approach to hypercalcemia
To diagnose hypercalcemia, repeat calcium levels should be obtained, and the calcium should be corrected for albumin levels. Additional tests such as phosphate, 25-hydroxyvitamin D, and parathyroid hormone (PTH) levels should also be considered. Physical exam and history should focus on dehydration, kidney stones, and medications that may contribute to high calcium levels.
Evaluating PTH-dependent hypercalcemia
If PTH levels are excessively elevated, primary hyperparathyroidism becomes a likely diagnosis. Age less than 50, very high calcium levels, renal dysfunction, prior kidney stones, and asymptomatic vertebral fractures are among the indications for possible parathyroidectomy.
Other considerations and management
Other factors to consider include the presence of lithium as a potential cause of hypercalcemia, monitoring bone health with bone density scans, and assessing for asymptomatic kidney stones. Hydration and management of underlying conditions are important aspects of treatment.
Diagnosing and Treating Primary Hyperparathyroidism
Primary hyperparathyroidism can be diagnosed through various assessments, including measuring PTH levels, conducting a 24-hour urine study, assessing bone density, and examining spinal films to identify asymptomatic vertebral fractures.
Managing Hypercalcemia
In cases of severe hypercalcemia, it is crucial to act quickly and address it as an emergent situation. Treatment options include administering fluids, using calcitonin and antiresorptive agents, and addressing the underlying cause, such as malignancies or granulomatous disorders.
Absorb all (but not too much) of the Calcium for your brain hole as Dr. Carl Pallais (Brigham and Women’s Hospital) walks us through his approach to Hypercalcemia. We learn about how tightly our body regulates calcium and what to do when that regulation goes awry. Not to mention that PTH is the name to remember (and phosphorus, if you need a quick stand-in while that PTH is pending).
Absorb all (but not too much) of the Calcium for your brain hole as Dr. Carl Pallais (Brigham and Women’s Hospital) walks us through his approach to Hypercalcemia. We learn about how tightly our body regulates calcium and what to do when that regulation goes awry. Not to mention that PTH is the name to remember (and phosphorus, if you need a quick stand-in while that PTH is pending).
Show Segments
Intro, disclaimer, guest bio
Dr. Pallais One-Liner
Case from Kashlak
Definitions: What’s a Normal Calcium Level, and how to adjust for Albumin
Causes of hypercalcemia
How Lithium works!
Testing for Hypercalcemia: Get that PTH, and that phos
Symptoms of Hypercalcemia, and Questions on History
Indications for Surgery for Parathyroidectomy
Management of Hypercalcemia and Hypercalcemic Emergency
Glass helps clinicians to draft differential diagnoses and draft clinical plans using physician-validated context. You can also use Glass to capture knowledge of all the schemas, scripts, cases, and pearls that you encounter and leverage them to take better care of patients.
Try Glass for yourself by visiting https://glass.health Personal knowledge management features are completely free and with Glass Pro, you get access to their powerful AI. You can get one month of Glass Pro free by signing up at https://glass.health and using the code CURBSIDERS.
Glass, like a clinical reference text or podcast, should never replace clinician judgment.
Sponsor - PatternAt Pattern, we give you a quick, simple way to compare and buy disability insurance. Busy doctors shouldn't have to worry about whether or not they are getting the best rates and discounts. Trying to research all your options and make the right decision while in training can make the process even more overwhelming. That’s why thousands of doctors trust Pattern to help them compare and understand the disability insurance they are buying.
We do this in three simple steps: First off, request your quotes online at patternlife.com/curbsiders. Second, compare your options and ask questions. And third, secure your policy!
So check disability insurance off your list today! Be confident that you have the right policy so that your income is protected. With huge discounts for doctors in training, now is truly the best time to request your disability insurance quotes with Pattern at patternlife.com/curbsiders.
Get the Snipd podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share & Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode