Lithium and Risk of Hypercalcemia & Hyperparathyroidism

This post will focus on:

1. Differentiate Lithium associated hypercalcemia/hyperparathyroidism from primary hyperparathyroidism.

2. Symptoms of hypercalcemia. 

3. Monitoring guideline. 

 

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	LITHIUM ASSOCIATED HYPER-CALCEMIA/ HYPER-PARATHYROIDISM	PRIMARY HYPER-PARATHYROIDISM
Serum Calcium	HIGH (mild- moderate elevation) +	HIGH (greater elevation) +++
iPTH	HIGH (high normal- mild elevation) +	HIGH (greater elevation) +++
Phosphate	Normal	LOW
Magnesium	HIGH +	Normal
Urine Calcium	LOW	HIGH

 

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SYMPTOMATIC HYPERCALCEMIA SYMPTOMS:

 

(a) STONES:

• Nephrolithiasis. 

• Renal dysfunction.

 

(b) BONES:

• Osteoporosis.

 

(c) GROANS:

• Peptic ulcers.

• Pancreatitis. 

 

(d) MOANS:

• Behavior and mood changes. 

 

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MONITORING GUIDELINES:

 

According to 2009 International Society for Bipolar Disorders guidelines:

• baseline calcium level 

• Followup level at 6 months, and 

• Annually after that. 

 

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Source:

• Am J Psychiatry. 2015 Jan;172(1):12-5.

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Please do post your questions or comments below. 

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