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. 

 


 

 

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

 


SYMPTOMATIC HYPERCALCEMIA SYMPTOMS:

 

(a) STONES:

  • Nephrolithiasis. 

  • Renal dysfunction.

 

(b) BONES:

  • Osteoporosis.

 

(c) GROANS:

  • Peptic ulcers.

  • Pancreatitis. 

 

(d) MOANS:

  • Behavior and mood changes. 

 


MONITORING GUIDELINES:

 

According to 2009 International Society for Bipolar Disorders guidelines:

  • baseline calcium level 

  • Followup level at 6 months, and 

  • Annually after that. 

 


Source:

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

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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