More than 90% of cases of hypercalcemia result from primary hyperparathyroidism or malignancy. Malignancies likely to cause hypercalcemia include squamous cell carcinoma of the lung; cancer of the breast, ovaries, prostate, bladder, kidney, neck, and head; leukemia; lymphoma; and multiple myeloma. These conditions raise serum calcium levels by destroying bone or by releasing PTH or a PTH-like substance (osteoclastic-activating factor), or prostaglandins. Other causes of hypercalcemia are vitamin D toxicity, the use of thiazide diuretics or lithium, sar-coidosis, immobilization, renal failure, excessive administration of calcium during cardiopul-monary arrest, and metabolic acidosis.

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