R> eg Patient feeling tired. Found to have 'elevated' calcium on 'routine'
R> blood test. At what concentration of calcium (and clinical picture) should
R> GP admit that day to hospital... or refer OPD?
Most patients will have primary hyperparathyroidism, and will
have had longstanding undetected hypercalcaemia. If the test was
truly random ie. could just have easily have been done last week,
last month or next month, I definitely wouldn't admit with a
calcium under 3.0mmol/L or so. Arrange some quick outpatient
investigations, and make sure they drink a bit of water. GP's
will only rarely see patients with serum calcium much greater
than 3, and even then, admission would not be in any way
mandatory. Some exercising of clinical judgement required. What
would the hospital actually do apart from the usual additional
dehydrating while waiting around? Patients who are not well or
who have a recent documented normal serum calcium clearly need
more attention.
In terms of "referral to OPD", I think simple investigation of
hypercalcaemia should be within the remit of every GP, and there
is no reason to think that GP's should not at least try to make a
rough diagnosis and direct their referral appropriately.
R> If (a different)patient on calcium or calcium/D3 how often do you check
R> serum calcium? All I've come across is 'monitor calcium on a regular basis'
Never (assuming we are talking about a straightforward patient on
say Calcichew D3 BD). No patients on these sorts of supplements
get significant hypercalcaemia or Vitamin D toxicity, although
patients with mild primary hyperparathyroidism might occasionally
be "unmasked". The BNF refers to the need to monitor patients
receiving PHARMACOLOGICAL amounts of Vitamin D. This means doses
of say 40,000 units daily, or 1 hydroxylated Vitamin D
derivatives. The amount of Vitamin D in calcium
and vitamin D supplements is not only not pharmacological, but is
near-homeopathic (200 Units daily or so - compare to around 10
times that amount obtained by doing a spot of sunbathing).
Aubrey
--
||=====================================================
|| Dr Aubrey Blumsohn
|| Senior Lecturer in Metabolic Bone Disease
|| Division of Clinical Sciences (NGHT)
|| Clinical Sciences Centre
|| Northern General Hospital, Herries Road
|| Sheffield S5 7AU, England
|| email: [log in to unmask]
|| phone: 114-271 5963 (office), 114 271 4705 (sec)
|| fax: 0114 261 8775 (fax)
||=====================================================
R> Many thanks
R> Rob
R> Dr Robert Lord
R> Department of Clinical Biochemistry
R> Rotherham District General Hospital
R> Moorgate Road
R> Oakwood
R> Rotherham
R> S60 2UD
R> Tel 01709 820000
R> E mail [log in to unmask]
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