Hypercalcemia in the elderly
Introduction
Introduction to hypercalcemia in the elderly Hypercalcemia may be a manifestation of a serious disease or malignancy, and can be found by laboratory tests in patients without significant signs of disease. Before analyzing hypercalcemia, it is important to ensure that there is hypercalcemia, not the false positive results found in laboratory tests. The presence of hypercalcemia was confirmed only after the adjusted serum calcium concentration exceeded 10.8 mg/dl (2.7 mmol/L) or the ionized calcium exceeded 5.4 mg/dl (1.35 mmol/L). Because hypercalcemia, whether persistent or intermittent, is always present, it can be diagnosed by multiple tests for fasting calcium. Once there is definitely hypercalcemia, the cause must be diagnosed. basic knowledge Sickness ratio: 0.5% Susceptible people: the elderly Mode of infection: non-infectious Complications: coma, hypertension, arrhythmia
Cause
Causes of hypercalcemia in the elderly
Body factor (90%):
Associated with the parathyroid glands, hyperparathyroidism and cancer account for 90% of the disease. It is related to high bone turnover rate. For the elderly, increased bone resorption is the main pathogenesis. Postmenopausal women lack of estrogen to counteract PTH to stimulate bone resorption, so that primary hyperparathyroidism increases; long-term calcium deficiency can also lead to secondary Sexual parathyroidism; chronic renal insufficiency can also pass through three hyperparathyroidism, leading to hypercalcemia, malignant tumors also cause hypercalcemia through increased bone resorption.
Other disease factors (10%):
Related to malignant tumors, related to vitamin D, and associated with renal failure. The main ways are: 1 localized osteolytic bone destruction caused by bone metastasis of malignant tumors such as breast cancer, 2 multiple myeloma and other hematological malignant tumors involving bone marrow, and malignant occurrence in lung, kidney and genitourinary system Tumor synthesis, secretion of some cytokines and tumor-related hormones, such as IL-1, IL-6, TNF-, parathyroid hormone-related protein (PTHrP), etc., leading to humoral hypercalcemia.
Pathogenesis
The pathogenesis is different, and its pathogenesis is also different. It comes down to four aspects: 1 increased bone resorption; 2 increased intestinal calcium absorption; 3 increased urinary calcium reabsorption; 4 blood concentration,
Prevention
Elderly hypercalcemia prevention
1. Among the measures for reducing blood calcium, most of the drugs are toxic, and their action time is short, which is not suitable for long-term application.
2. The blood calcium has been urgently treated to a normal level, and the cause should be properly treated.
Complication
Elderly hypercalcemia complications Complications, coma, hypertension, arrhythmia
Can be complicated by neurological symptoms such as coma, high blood pressure, arrhythmia, cardiac arrest and so on.
Symptom
Hypercalcemia symptoms in the elderly Common symptoms Fatigue calcification polyuria depression constipation nausea coma cardiac arrest
Hypercalcemia caused by any cause can cause fatigue, depression, confusion, fear of eating, nausea, vomiting, constipation, reversible tubular dysfunction, polyuria, electrocardiogram changes (QT interval shortening, or even heart rhythm) Symptoms, there is no definite correlation between the severity of hypercalcemia and the symptoms. Usually, the blood calcium level is higher than 2.9-3.0mmol/L (11.512.0mg/dl), but the symptoms appear more, but There are exceptions; when the blood calcium level exceeds 3.2mmol/L (13.0mg/dl), renal insufficiency and calcification of the skin, blood vessels, heart, lungs, kidneys, etc., especially blood phosphate levels, can occur. Or due to impaired renal function and elevated blood phosphate levels, the so-called severe hypercalcemia generally refers to a medical emergency of blood calcium 3.7mmol / L (15.0mg / dl), patients often have coma and cardiac arrest .
Examine
Examination of hypercalcemia in the elderly
Blood test, serum calcium > 2.75mmol / L, increased urea nitrogen.
Electrocardiogram: ST segment shortened, T wave low or inverted, can have different degrees of conduction block, X-ray can be found in calcium deposition, kidney stones, bone changes.
Diagnosis
Diagnosis and differential diagnosis of hypercalcemia in the elderly
The diagnosis of hypercalcemia is not difficult. It is difficult to diagnose the cause of hypercalcemia as long as the corrected serum calcium concentration exceeds 10.8 mg/dl (2.7 mmol/L) or the ionized calcium exceeds 5.4 mg/dl (1.35 mmol). /L) can diagnose hypercalcemia, sometimes it needs to be diagnosed by multiple tests.
Usually, asymptomatic hypercalcemia is usually seen in primary hyperparathyroidism; in most cases, hypercalcemia caused by malignant tumors is severe and difficult to treat (such as accompanied by anemia, weight loss, low Proteinemia, etc., and patients with malignant tumors often have less than 6 months from the discovery of hypercalcemia to death; if the patient has no other symptoms and only hypercalcemia, or some manifestations of hypercalcemia If the time of kidney stone is as long as 1 to 2 years, the possibility of malignant tumor is very small, which is clinically helpful in the identification of hypercalcemia. In addition, radioimmunoassay (double antibody) is used to detect PTH and specific radioimmunoassay. Analytical detection of PFHrP in blood is of great significance for the differential diagnosis of hypercalcemia; careful understanding of the patient's eating habits and the history of taking various vitamins and drugs can not be underestimated for the discovery of certain rare causes, For patients with granulomatous diseases such as vitamin D3 poisoning or sarcoidosis, the detection of plasma 25(OH)D3, or 1,25-(OH)2D3 levels has important identification value.
