Milk-Alkali Syndrome and Evaluation of Hypercalcemia. Morning Report 8/18/2009 TJ O’Neill. Hypercalcemia. Occurs when entry of Calcium (from GI tract and bone) exceeds rate of loss (urine loss and bone deposition) Should be confirmed with albumin level and preferable ionized Ca.
Analyze Vit D metabolites
Calcidiol (25 OH) and calcitriol (1,25OH) should be measured if there is no obvious malignancy and neither PTH nor PTH-rp levels are elevated
Elevated calcidiol is indicative of vitamin D intoxication due to the ingestion of either vitamin D or calcidiol itself
Elevated calcitriol may be induced by direct intake of this metabolite, extrarenal production in granulomatous diseases or lymphoma, or increased renal production that can be induced by primary hyperparathyroidism but not by PTH-rp