Hypercalcemia in MRCP(2)

Hypercalcemia in MRCP(2)

As a medical student many years ago, I remembered I have to memorize a lot of medical mnemonics. It is easy to remember how a patient with hypercalcemia presents to hospital, just remember this sentence,

“ STONES, BONES, ABDOMINAL MOANS, AND PSYCHIC GROANS”

Let me explain these symptoms briefly,

1) Stone-

I think it is rather straightforward, high calcium in the blood also translates high calcium in the urine, therefore you are prone to get stone. Besides that, patients with hypercalcemia also easily get dehydration because they might have polyuria due to nephrogenic diabetes insipidus.

2) Abdominal moans-

Hypercalcemia leads to constipation, abdominal colic and pancreatitis.

3) Bones-

You get bone pain because there is increased in bone resorption/ breakdown due to tumour ( causing pathological fracture) or hyperparathyroidism.

4) Psychic groans-

I can’t explain this, hypercalcemia can cause psychosis, confusion etc. You have to remember it!!But I think all the electrolyte imbalances can cause some kind of mental problems.

About the treatment of hypercalcemia, I think it is not so important to remember, anyway, remember the following strategies,
1) Rehydration

2) Steroids

3) Calcitonin

4) Biophosphonates

5) Plicamycin

6) Dialysis

7) And of course, treat the underlying cause!!

However, just want to remind all of you, there are a few causes of hypercalcemia that you might can’t explain the mechanism involved but they are important. These causes are thyrotoxicosis, Addison’s disease and acromegaly.

If you can explain the mechanism involved, please share with other readers!!

Hypercalcemia in MRCP (1)

Hypercalcemia in MRCP

As a houseofficer many years ago, I remember that there are two electrolytes that are frequently encountered during clinical practice- Potassium and Calcium.

We have discussed a lot about Potassium, I am going to talk about Calcium metabolism today and of course talk more about hypercalcemia.

It is pretty easy to remember, the only pool of calcium in our body is bone. Although tiny amount of calcium is being absorbed through the gut ( affected by Vitamin D), maintenance of normal calcium level in serum ( 2.2-2.6) greatly depends on exchange of Calcium between extracellular fluid and bone.


It is easy to remember that if we have low calcium level, our body will try to do the followings to increase calcium level in the serum,

1) Increase Calcium absorption from the gut
2) Increase bone resorption in the bone so that more calcium can be released to the serum
3) Reduce Calcium excretion from the kidney

The main organ that regulates these is parathyroid hormone. You can think of causes of hypercalcemia into a few big groups as below,

1) Bone problem
It is easy to understand this, when there is increased bone destruction, of course you calcium level is high. Therefore, any malignant disease either primary or secondary that leads to bone destructions can cause hypercalcemia.

2) Vitamin D problem
As I said before, Calcium absorption from the gut is mainly affected by Vitamin D, therefore, Vitamin D toxicity or granulomatous diseases ( such as Sarcoidosis or tuberculosis) can cause hypercalcemia.

3) Parathyroid hormone
Of course, when you have high parathyroid hormone ( primary and secondary), you calcium level is high but remember that secondary hyperparathyroidism may have normal or even low Calcium level.

4) Others
Some other rare causes such as Familial hypocalciuric hypercalcemia, milk alkali syndrome, immobility etc.