Hypercalcemia is a condition in which the calcium level in the blood is above normal. Too much calcium in your blood can weaken the bones, create kidney stones, and interfere with how the heart and brain work. Show
Hypercalcemia is usually a result of overactive parathyroid glands. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements[1].
Epidemiolgy[edit | edit source]The prevalence of hypercalcemia in the general population is approximately 1% to 2%. Most of the cases (90%) of hypercalcemia are due to primary hyperparathyroidism and malignancy-associated hypercalcemia[3]. Etiology[edit | edit source]Common causes of hypercalcemia include: [4]
Characteristics/Clinical Presentation[edit | edit source]Many of the symptoms of hypercalcemia are ones that are characteristic of other conditions. More-severe cases produce signs and symptoms related to the parts of the body affected by the high calcium levels in the blood. Examples include: Severe hypercalcemia inhibits neuromuscular and myocardial depolarization leading to muscle weakness and arrhythmias.[3] Diagnosis[edit | edit source]Hypercalcemia is diagnosed by blood tests revealing increased serum calcium levels. However, other tests may need to be done in order to determine the underlying cause of hypercalcemia. These may include: Chest X-Ray; CT Scan; MRI; Mammogram These tests may help determine whether client has lung cancer, breast cancer, other malignancies, or sarcoidosis (a granulomatous disease of the lungs). [5] Treatment[edit | edit source]The treatment of hypercalcemia varies depending upon how elevated the calcium is, as well as the cause. Medical approaches used to decrease blood calcium level include medications and interventions. All clinicians and nurses should educate the patients on maintaining hydration, changes in diet and limiting calcium intake. The patient and family should be told about the symptoms of hypercalcemia and when to seek assistance. Physical therapy should be involved to ensure that the patient remains mobile and active (see below). If the patient has a metastatic disease associated with hypercalcemia, the hospice, palliative care, and pain teams should be involved to ensure that the quality of life is not compromised. A dietitian should be consulted to educate the patient on what type of foods to avoid. With such a team approach, it is hoped that the patient outcomes will improve. Medications used to treat hypercalcemia include:
If hypercalcemia is very severe, dialysis may be needed.[6] Physical Therapy Management[edit | edit source]
Prognosis[edit | edit source]The prognosis of patients with hypercalcemia depends upon the etiology of the elevation:[7]
References[edit | edit source]
Excessive calcium levels in the blood (hypercalcemia) usually occurs as a result of other conditions. Treatment depends on the cause of the disease, but may be as simple as changing certain medicines.
Hypercalcemia, or higher than normal level of calcium in your blood, is a fairly common finding. Blood tests, such as those drawn for an annual physical exam, today routinely check calcium levels. This allows physicians to detect abnormally high calcium levels early. Calcium is an important mineral in our bodies throughout our lifetime for bone growth, bone strength, maintaining proper hormone levels and optimal functioning of nerves, muscles and the brain. The calcium level is usually very carefully controlled by the body. However, certain medications and conditions can result in high blood calcium levels. In the past, complications such as bone loss and fractures, kidney stones, kidney failure, hypertension and bradycardia (slowed heart rate), were commonly found as a result of longstanding untreated high calcium levels. These are now rarely seen thanks to blood tests that lead to preventive treatment.
Hypercalcemia can be caused by more than 25 separate diseases, several medications and even dehydration. Primary hyperparathyroidism and various kinds of cancers account for the greatest percentage of all patients with hypercalcemia. In primary hyperparathyroidism, one or more of the four parathyroid glands, located behind the thyroid gland in your neck, produce too much parathyroid hormone. Normally, the parathyroid glands work with the kidneys, skeleton and intestines to carefully regulate the level of blood calcium. But sometimes a parathyroid gland becomes overactive, resulting in excess parathyroid hormone being released and an elevated blood calcium level. Common medications such as hydrochlorothiazide and other thiazide diuretics (prescribed for hypertension and edema), lithium, and excessive intake of vitamin D, vitamin A or calcium can result in hypercalcemia. Taking too much calcium carbonate in the form of Tums® or Rolaids® is actually one of the more common causes of hypercalcemia. Lung cancer, breast cancer and certain cancers of the blood can cause hypercalcemia that can become severe. Other less common causes of hypercalcemia include: What are the symptoms of hypercalcemia?Although having symptoms of hypercalcemia is uncommon, symptoms can include:
Your doctor will order a blood test to determine if you have hypercalcemia. If the calcium is elevated, your physician will often review your medications and medical history as well as conduct a physical exam. If there is no obvious cause, your physician may ask you to see an endocrinologist, who will give you further evaluation and testing.
Treatment of hypercalcemia depends on what is causing the disorder and how severe it is. Often the doctor may tell you calcium levels can be lowered if you:
If the hypercalcemia is due to an overactive parathyroid gland, your doctor can consider several options:
If the hypercalcemia is severe, and/or causing significant symptoms, your doctor may recommend immediate hospitalization for intravenous fluids and other treatments.
Not all hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets is recommended. Be sure to talk with your doctor if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your doctor.
Prognosis, like treatment, depends on the cause and severity of hypercalcemia. If the serum calcium is only slightly elevated, you will probably have few or no health complications. When hypercalcemia is the result of an underlying medical condition or disease, the prognosis depends on your overall health and your specific circumstances.
Last reviewed by a Cleveland Clinic medical professional on 07/02/2018. References
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