VA Report Pearls: Hypercalcemia!

Pearl of the Day: In cases of hypercalcemia, a chloride/phosphate ratio of >33 has very high sensitivity and specificity for hyperparathyroidism.

Take Home Points:
1) In cases of hypercalcemia, a chloride/phosphate ratio of >33 has very high sensitivity and specificity for hyperparathyroidism. In the attached article, the ratio was found to be “higher than 33 in 94 percent of hyperparathyroid patients and lower than 33 in 96 percent of other hypercalcemic patients.” 

2) The first branch point in the evaluation of hypercalcemia is the PTH. Order this first!

 3) See attached for a great review of Hypercalcemia from the AAFP. 

 4) The Mini-Cog is a 2-part screening tool for dementia that is as good (if not better) than the longer Mini Mental Status Exam (MMSE)

Step 1: Ask patient to repeat three unrelated words
Step 2: Ask the patient to draw a simple clock set to “10 minutes after eleven o’clock”
Step 3: Ask the patient to recall the three words from Step 1.

To assess:
If patient recalled 0/3 items: positive dementia screen (regardless of clock)
if patient recalled 3/3 items: negative dementia screen (regardless of clock)
If patient recalled 1-2/3 items: look at clock, if abnormal, then positive dementia screen

Ebell M. Brief Screening Instruments for Dementia in Primary Care. Am Fam Physician. 2009 Mar 15;79(6):497-500. 

Carroll MF, Schade DS. A Practical Approach to Hypercalcemia. Am Fam Physician. 2003;67:1959-1966.

Reeves et al. Differential Diagnosis of Hypercalcemia by the Chloride/Phosphate Ratio. The American Journal of Surgery. 1975;130:166-171.

 

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