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Hypercalcemia

Definition

Calcium is a mineral needed for bone health, muscle movement, and nerve function. Hypercalcemia is higher than normal levels of calcium in your blood.
High levels can cause several problems throughout the body. Long-term high calcium levels can also lead to kidney stones.
Kidney Stones
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Causes

Vitamin D helps to absorb calcium from food or supplements. Once in your body, calcium may be stored in the bones or exist in the blood and cells. Levels of calcium in the blood are normally regulated by hormones from the parathyroid gland. Calcium is excreted through the kidneys.
Hypercalcemia may occur if an illness or medication interferes with this process or destroys bone and other tissue releasing extra calcium into the blood .The most common causes of hypercalcemia are cancer or an overactive parathyroid gland.
Dehydration can also cause a temporary hypercalcemia. Decreased fluid in the blood causes an increase in concentration, but not amount of calcium.

Risk Factors

Factors that may interfere with hormones and lead to hypercalcemia include:
  • Certain types of brain cancer
  • Parathyroid problems
  • Certain disorders such as adrenal insufficiency and acromegaly
  • Certain medications such as lithium
Factors that may increase the amount of calcium in the body or blood include:
  • Excess vitamin D and/or vitamin A supplements—increases absorption of calcium and release of calcium from the bones into the blood
  • Certain medications, including diuretics that reduce the amount of calcium eliminated and calcium-containing antacids
  • Certain diseases associated with inflammation such as sarcoidosis, berylliosis, or tuberculosis
  • Hodgkin lymphoma
Other factors that may increase your risk of hypercalcemia include:
  • Cancer or treatment for cancer—causes release of calcium from damaged cells or bones
  • Genetic disorders
  • Phosphate deficiency in newborns
  • Kidney disease or failure—cannot get rid of calcium

Symptoms

Symptoms may include:
  • Bone pain
  • Muscle weakness
  • Constipation
  • Nausea and vomiting
  • Irregular heartbeat
  • Fatigue
  • Appetite loss and weight loss
  • Abdominal pain
  • Difficulty concentrating and memory problems
  • Itching

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids will be tested. This can be done with:
  • Blood tests
  • Urine tests
If hypercalcemia is associated with a parathyroid problem or cancer your doctor may need images with:
Other tests may be done to look for any effects of hypercalcemia such as:

Treatment

Treatment will depend on the cause of hypercalcemia. Talk with your doctor about the best treatment plan for you. Options include:

Rehydration and Medications

IV fluids may be given to help flush out the excess calcium.
Medication may also be given to control the condition causing the problem or to encourage removal of calcium from the blood. Medication options may include:
  • Bisphosphonates
  • Calcitonin
  • Glucocorticoids

Other Supportive Steps

Other treatments depend on the cause of your hypercalcemia but may include:
  • Limiting your intake of calcium and vitamin D. You may be referred to a dietitian.
  • Parathyroid surgery may be needed to treat hypercalcemia in patients with hyperparathyroidism.
  • Dialysis—for severe cases of hypercalcemia due to kidney failure.

Prevention

To help reduce your chance of getting hypercalcemia your doctor may:
  • Treat any underlying causes, such as hyperparathyroidism.
  • Use bisphosphonates when there is cancer in the bones.

RESOURCES

American Academy of Family Physicians
http://www.aafp.org
American Association of Clinical Endocrinologists
http://www.aace.com

CANADIAN RESOURCES

The Canadian Society of Endocrinology and Metabolism
http://www.endo-metab.ca
Health Canada
http://www.hc-sc.gc.ca

References

Carroll M, Schade D. A practical approach to hypercalcemia. Am Fam Physician. 2003 May 1;67(9):1959-1966.
Hypercalcemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 18, 2014. Accessed November 6, 2014.
Hypercalcaemia. Patient UK website. Available at: http://www.patient.co.uk/doctor/Hypercalcaemia.htm. Updated March 3, 2014. Accessed January 8, 2013.

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