Hypercalcemia

Hypercalcemia, defined as ionized calcium greater than 10.5 mg/dL, is the central topic, particularly its manifestation, diagnosis, and treatment within the surgical ICU. Common symptoms include altered mental status, hyporeflexia, and muscle weakness, while chronic cases may show bone changes. The causes range from malignancy, often releasing parathyroid hormone-related peptide, to granulomatous diseases like sarcoidosis and vitamin A toxicity. Treatment strategies involve a four-pronged approach: expanding extracellular volume with saline, administering loop diuretics like Lasix to enhance renal calcium excretion, and using calcitonin and bisphosphonates to decrease bone mobilization. While bisphosphonates such as Pimidronate offer long-term management by inhibiting osteoclasts, calcitonin provides quicker initial relief by promoting renal calcium excretion and inhibiting bone reabsorption.