Stony Stella — Hypercalcemia
Stones, bones, groans and psychiatric overtones
Stella turns to stone from the inside out. Calcium leaches out of her bones, settles in her kidneys and slows every muscle and thought she has.
Stella's calcium is above 10.5 from malignancy or hyperparathyroidism. Everything slows: constipation, lethargy, weak reflexes, kidney stones and bone pain. Isotonic fluids first, then calcitonin and bisphosphonates; keep her moving and safe from fractures.
Read Stony Stella's full story →The story arc
The setup
Metastatic breast cancer erodes bone and dumps calcium into her blood while she stays in bed for weeks.
The turn
She becomes constipated, drinks constantly, urinates constantly, and her family says she is 'not herself.'
The crisis
Calcium is 14.2, she is lethargic and her ECG shows a shortened QT with bradycardia.
The save
Isotonic saline restores volume and promotes excretion, calcitonin works fast, and a bisphosphonate holds the line.
NCLEX study section — Hypercalcemia
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.