Hypercalcaemic hyperparathyroid crisis.
### Learning Point for Clinicians

Hypercalcaemic hyperparathyroid crisis is a rare but dangerous life-threatening manifestation of parathyroid disease. Initial management includes aggressive rehydration and intravenous bisphosphonate therapy. Definitive management involves parathyroidectomy. Accurate identification and prompt management is required to avert potentially life-threatening complications of this condition.

A 63-year-old woman presented to the medical assessment unit with a three week history of vomiting, polydipsia, polyuria and constipation. She had no history of renal stones, osteoporosis or low mood. The patient had a longstanding history of hypertension for which she was receiving propranolol and type 2 diabetes mellitus, treated with metformin.

She was mildly confused being orientated to person and place but not to time. She had an otherwise normal physical examination. Her pulse was 84, regular in rhythm and normal in character. Her …