The Curbsiders Internal Medicine Podcast

REBOOT #281 Hypercalcemia: Calci-fun! with Dr. Carl Pallais

7 snips

Dec 18, 2023

Dr. Carl Pallais, an expert in Hypercalcemia, discusses the regulation of calcium in the body and what happens when it goes wrong. Topics covered include the importance of PTH and phosphorus, causes of hypercalcemia, testing for hypercalcemia, symptoms and history, indications for surgery, and management of hypercalcemia.

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ADVICE

Confirm Elevated Calcium Before Acting

Repeat unexpected high calcium and correct for albumin before escalating the workup.
Use ionized calcium only inpatient or when sample handling is guaranteed to be rapid and on ice.

INSIGHT

PTH-Based Diagnostic Framework

Divide hypercalcemia into PTH-dependent and PTH-independent causes to narrow testing.
Primary hyperparathyroidism dominates outpatient cases; malignancy dominates inpatient cases.

INSIGHT

Calcium Sensing Explains Lithium Effects

The calcium-sensing receptor in parathyroid and kidney tightly controls PTH and renal calcium handling.
Lithium blunts that sensing, causing mild PTH-mediated hypercalcemia and low urinary calcium.

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Absorb all (but not too much) of the Calcium for your brain hole as Dr. Carl Pallais (Brigham and Women’s Hospital) walks us through his approach to Hypercalcemia. We learn about how tightly our body regulates calcium and what to do when that regulation goes awry. Not to mention that PTH is the name to remember (and phosphorus, if you need a quick stand-in while that PTH is pending).

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Absorb all (but not too much) of the Calcium for your brain hole as Dr. Carl Pallais (Brigham and Women’s Hospital) walks us through his approach to Hypercalcemia. We learn about how tightly our body regulates calcium and what to do when that regulation goes awry. Not to mention that PTH is the name to remember (and phosphorus, if you need a quick stand-in while that PTH is pending).

Show Segments

Intro, disclaimer, guest bio
Dr. Pallais One-Liner
Case from Kashlak
Definitions: What’s a Normal Calcium Level, and how to adjust for Albumin
Causes of hypercalcemia
How Lithium works!
Testing for Hypercalcemia: Get that PTH, and that phos
Symptoms of Hypercalcemia, and Questions on History
Indications for Surgery for Parathyroidectomy
Management of Hypercalcemia and Hypercalcemic Emergency
Outro

Credits

Producer, Writer, Infographic, Cover Art: Nora Taranto MD
Hosts: Matthew Watto MD, FACP; Nora Taranto MD
Reviewer: Yan Emily Yuan MD, MSc
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
Guest: Carl Pallais MD, MPH

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