Hypercalcemic Crisis

Hiroshi Takami, MD

The most generally accepted criteria for the diagnosis of hypercalcemic crisis include a statement about the severity of the hypercalcemia (usually Ca >14.5 mg/dL)1 and that it is associated with acute symptoms and signs that can be reversed by correcting the hypercalcemia.1 Primary hyperparathyroidism (PHPT) and malignancy are the main causes of hypercalcemic crisis. Hypercalcemic crisis secondary to PHPT has been referred to in the literature as acute HPT, parathyroid crisis, parathyroid poisoning, parathyroid intoxication, parathyrotoxicosis, and parathyroid storm.2*6 The manifestations include weakness, nausea and vomiting, drowsiness, stupor, coma, constipation, and tachycardia.7 8 Severe life-threatening symptoms and signs of hypercalcemia constitute a "crisis," and rapid diagnosis and treatment are essential to avoid significant morbidity or mortality.9 The emergency treatment of hypercalcemic crisis is the same regardless of the cause, and an emergency diagnostic algorithm must be followed to demonstrate or rule out PHPT. Serum calcium should be lowered during the etiologic work-up for hypercalcemia. Earlier fluid replenishment and optimized strategies for the intensive care of critically ill hypercalcemic patients have made hypercalcemic crisis a rare event.10

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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