HyperCalcemia_1

HyperCalcemia_1

1. >10.5mg/dL

   • Serum calcium so high that calcium control mechanisms cannot keep up, or other control mechanism has failed

2. MILD-first causes increase in HR&BP

   • Prolonged/Severe-depression of electrical impulses leads to slow HR
     • Check EKG for dysrhythmias---shortend QT interval
   • Check pulse and BP. Check perfusion, pallor, cyanosis

3. Increased risk of blood clots

4. Neuro Changes

   • Severe muscle weakness, decreased DTR, s parasthesia; ALOC(lethargy-coma), psych probs

5. GI: decreased peristalsis, Constipation, anorexia, N&V, abd. pain. hypoactive/absent bowel sounds

   • Measure abd. girth in circle around navel

6. Excessive PO intake of calcium, excessive Vit. D intake, kidney failure, thiazide diuretics

   • Actual

7. Relative Excess

   • Hyperparathyroidism, Malignancy: Direct invasion/ indirect resorption, hyperthyroidism, Immobility, glucocorticoids, Dehydration

8. Tx: Stop IV solutions c calcium. Fluid volume replacement.

   • 0.9 Sodium chloride- sodium helps renal excretion of calcium
   • D/c Thiazide; replace c furosemide
   • Calcium Chelators- plicamycin, penicillamine
   • Dialysis for severe; rapid decrease in levels
     • Hemo Dialysis; blood ultrafiltration

9. Prevent

   • Calcium resorption inhibitors- phosphorus, calcitonin, bisphosphates, prostaglandin synthesis inhibtors

10. Cardiac monitoring to ID dysrhythmias et decreased output. Compare new ECG c baseline. Esp. Check for changes in T waves et QT interval, rate and rhythm changes too