Hypercalcemia

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Hypercalcemia

Confirm serum calcium with ionized Ca

No hypercalcemia

Elevated serum Calcium

iPTH

Elevated iPTH

Ddx: Primary hyperparathryoidism

Mid-upper Normal iPTH

Ddx: FFH

Low iPTH

Measure PTHrP

Normal

Measure 1, 25 (OH)2 vitamin D

Low/Normal

Measure 25 (OH) vitamin D

Ddx: multiple myeloma, medication reaction

Ddx: Vitamin D intoxication

Likely ddx: lymphoma, granulomatous disease

Elevated

Hypercalcemia of malignancy: Squamous cell carcinomas, Adenocarcinoma of the lung, pancreas, kidney, Breast cancer, Thyroid cancer, Leukemia, Plasma cell myeloma, Hodgkin disease

EKG

Tall, possible peaked T-waves, Short QT interval, Possible P-wave disappearance, Heart block, Bradyarrhythmia

Consistent with hypercalcemia