A 70 year old female presents with confusion and weakness

Very severe hypercalcaemia in a patient with history of thyroid disease.

Causes of hypercalcaemia:

Thyrotoxicosis

Inflammatory disorders

Malignancy

Immobilisation

Drugs – Thiazides

Rhabdomyolysis

Addison’s disease

Sarcoidosis

Paget’s disease, Parenteral nutrition, Parathyroid disease.

Vitamins A & D excess

Milk-alkali syndrome

AIDS

Treatment:

The patient requires admission for workup of the possible causes for her hypercalcaemia

Fluid rehydration

Encourage mobilisation and weight bearing

Others depend on the cause identified:

Reduce dietary intake of Calcium and Vit D

Long term treatment may include the use of Bisphosphonates to reduce bone resorption esp in Malignancy, other agents – Immune mediators/ suppressors, hormonal therapy with Calcitonin/ steroids etc

Surgery

Orthopaedic input for possible Orthopaedic complications