QuestionSBA
QuestionChoice
Paracetamol does not commonly cause hypercalcaemia.
50388
e
Paracetamol 1g PO QDS
QuestionChoice
Amlodipine does not commonly cause hypercalcaemia. In very rare cases it has been found to cause hypocalcaemia.
50386
c
Amlodipine 10mg PO OD
QuestionChoice
Atorvastatin does not commonly cause hypercalcaemia.
50387
d
Atorvastatin 20mg PO OD
QuestionChoice
Indapamide is a thiazide-like diuretic. Thiazide-like diuretics work via increasing the availability of Na<sup>+</sup> in the urine, water then follows this and reduces the blood pressure. One way they do this is by increasing calcium reabsorption across the nephron in exchange for sodium - this in turn results in hypercalcaemia.
50384
a
Indapamide 2.5mg PO OD
QuestionChoice
Ramipril does not commonly cause hypercalcaemia.
50385
b
Ramipril 10mg PO OD
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3660
Indapamide can cause hypercalcaemia
Topic
9
Internal Medicine
10131
Case Presentation: A 72-year-old gentleman attends his GP for his blood results. His regular medicines are listed (below).




 **PH** Hypertension, Hypercholesterolaemia


 **DH** Atorvastatin 20mg PO OD, Ramipril 10mg PO OD, Amlodipine 10mg PO OD, Indapamide 2.5mg PO OD, Paracetamol 1g PO QDS


 **On examination**
BP 148/90mmHg, HR 84, RR 12, Weight 70kg


 **Investigation**


||||
|---------------------------|:-------:|--------------------|
|Sodium|136 mmol/L|135 - 145|
|Potassium|4.1 mmol/L|3.5 - 5.3|
|Urea|6.0 mmol/L|2.5 - 7.8|
|Creatinine|100 µmol/L|60 - 120|
|Calcium|3.0 mmol/L|2.2 - 2.6|
|eGFR|70 mL/min/1.73m<sup>2</sup>|> 60|


Question: Select the medication that is most likely to have contributed to the abnormality in his blood results.
a