The video version of this podcast can be found here: · https://youtu.be/2scjC_NoKfc This episode makes reference to guidelines produced for the Maidstone and Tunbridge Wells NHS Trust, and NHS Greater Glasgow and Clyde. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the guidance on hypercalcaemia produced by the Maidstone and Tunbridge Wells NHS Trust, and the guidance in NHS Greater Glasgow and Clyde, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this episode is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: ● Apple podcast: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148● Spotify: https://open.spotify.com/show/2kmGZkt1ssZ9Ei8n8mMaE0?si=9d30d1993449494e● Amazon Music: https://music.amazon.co.uk/podcasts/0edb5fd8-affb-4c5a-9a6d-6962c1b7f0a1/primary-care-guidelines?ref=dm_sh_NnjF2h4UuQxyX0X3Lb3WQtR5P● Google Podcast: https://www.google.com/podcasts?feed=aHR0cHM6Ly9mZWVkcy5yZWRjaXJjbGUuY29tLzI1ODdhZDc4LTc3MzAtNDhmNi04OTRlLWYxZjQxNzhlMzdjMw%3D%3D● Redcircle: https://redcircle.com/shows/2587ad78-7730-48f6-894e-f1f4178e37c3 There is a YouTube version of this and other videos that you can access here: ● The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here:The guidance on the treatment of hypercalcaemia in adults by the Maidstone and Tunbridge Wells NHS Trust can be found here:· https://www.formularywkccgmtw.co.uk/media/1629/treatment-of-acute-hypercalcaemia-in-adults.pdf The guidance on the management of hypercalcaemia by the Adult Therapeutics Handbook for the NHS Greater Glasgow and Clyde can be found here: · https://handbook.ggcmedicines.org.uk/guidelines/electrolyte-disturbances/management-of-hypercalcaemia/ Other guidance can be found here: Joshi D, Center JR, Eisman JA. Investigation of incidental hypercalcaemia. BMJ. 2009;339:b4613· http://www.ncbi.nlm.nih.gov/pubmed/19933303 Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003;67(9):1959-66· http://www.ncbi.nlm.nih.gov/pubmed/12751658 Smellie WS et al. Best practice in primary care pathology: review 11. J Clin Pathol. 2008;61(4):410-8· http://www.ncbi.nlm.nih.gov/pubmed/17965216 Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] ● Music provided by Audio Library Plus ● Watch: https://youtu.be/aBGk6aJM3IU ● Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the guidance on hypercalcaemia produced by the Maidstone and Tunbridge Wells NHS Trust, as well as other general guidance on the subject, always focusing on what is relevant in Primary Care only. The links to the information consulted can be found in the episode description. Right, let’s not waste any more time so let’s jump into it. Before we start, let’s quickly have an overview of calcium metabolism. Calcium is one of the most abundant electrolytes in the body, and levels are tightly controlled by parathyroid hormone and vitamin D. Serum calcium is bound to albumin, and measurements should be adjusted for it, so we should be primarily concerned about corrected calcium levels. Calcium is mostly absorbed in the small intestine and active vitamin D (or calcitriol) enhances calcium absorption. Parathyroid Hormone (or PTH) is also important. When blood calcium levels drop, PTH is secreted, which enhances calcium reabsorption in the kidneys, and also stimulates osteoclasts in the bones, breaking down bone tissue and releasing calcium into the blood stream. This is precisely the opposite effect of calcitonin, which inhibits osteoclast and reduces bone resorption and calcium levels. So, from a pathophysiological perspective, a high calcium or hypercalcemia can be seen in, for example, hyperparathyroidism, malignancy, or excessive vitamin D intake. There are also pathophysiological interactions between calcium and levels of phosphate and magnesium. For example, a high calcium can suppress magnesium renal ...
