ISSN: 2642-6250
Authors: Suresh K*
Objective: In this article I present 2 cases of hypercalcaemia identified and managed in 2021 in smaller settings and review of literature of such cases in bigger facilities India with an objective of alerting private practitioners’ role in managing such cases efficiently. Hypercalcaemia is not a disease but just a biomarker of a total serum calcium concentration > 10.4 mg/dL (> 2.60 mmol/L) or ionized serum calcium > 5.2 mg/dL (> 1.30 mmol/L). Principal causes include Primary hyperparathyroidism, vitamin D toxicity, and cancer. The serum Calcium and Phosphorous (Ca/P) ratio is a most valuable tool for the diagnosis of Primary hyperparathyroidism, better than serum Calcium alone. Locations of cases reported: Kalimpong in West Bengal and Chikkaballapur near Bengaluru Participants: i) A - 66-year-old Kamala Pradhan, a known diabetic, my patient in Delhi for last 5 years presenting with pruritus, muscle weakness, lack of appetite and weight lost for 3 months and accidentally diagnosed after a Blood test as moderate hypercalcaemic due to over consumption of Vit. D (weekly 60 K units for 3 years) and ii) the second case of a rural 45 year’s old women from Bengaluru in May 2021 diagnosed as Cancer Cervix stage 3 at a private cancer hospital in Bangalore who succumbed in about 3 week’s time Measurements: i) In the first a serum test indicated serum Calcium level 20 mg/dl and Vitamin D 150ng/ml in first test and after management for a months’ time Calcium levels came down to 10mg/dl and Vitamin D levels to 50ng/ml. ii) Second case had calcium level of 120 mg/dl indicating Calcium crisis. Results: The first case of moderate hypercalcemia due to Vit D intoxication improved, the Calcium level came down to 10mg/dl and D Vitamin came down to 50ng/ml with clinical improvements in 12 weeks’ time. The Calcaemic crisis was not monitored as the patient died within 3 weeks of starting treatment. Conclusion: A case of successful management of moderate due to Vitamin D intoxication and another case of calcinemia crisis due to advanced cervical cancer, with serious complications, and death are reported for education of general practitioners. Material & Methods: The author a family physician for 54 years and a Public Health practitioner for 45 years, have used 2 cases of hypercalcaemia followed in 2021 and review some other published cases, along with a few retrospective studies in India and abroad, that lead to hypercalcaemia and current recommendations for the management of elevated serum calcium levels.
Keywords: Hypercalcaemia; Hyperparathyroidism; Hyperparathyroidism Screening; Diagnosis; Hypercalcemia; Hypophosphatemia; Vit. D Intoxication; Malignancies
