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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. Excess calcium may be excreted through the kidneys. Levels of calcium in the blood are normally regulated by hormones from the parathyroid gland. Hypercalcemia may occur if an illness or medication interferes with this process. The most common cause of hypercalcemia is an overactive parathyroid gland.
Dehydration can also cause a temporary hypercalcemia. Decreased fluid in the blood causes an increase in concentration of calcium.

Risk Factors

Factors that may interfere with hormones and lead to hypercalcemia include:
  • Certain types of cancer
  • Thyroid 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 include:
  • Excess vitamin D and/or vitamin A supplements—increases absorption of calcium
  • Certain medications, including diuretics 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:
  • Excess vitamin D—causes release of calcium from the bones into the blood
  • Cancer or treatment for cancer—causes release of calcium from damaged cells
  • 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
  • Weight loss
  • Fatigue
  • Abdominal pain
  • Dehydration
  • Difficulty concentrating and memory problems
  • Itching
  • Irregular heartbeat

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 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, manage conditions such as hyperparathyroidism.

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 November 13, 2013. Accessed January 8, 2013.

Hypercalcaemia. Patient UK website. Available at: http://www.patient.co.uk/doctor/Hypercalcaemia.htm. Updated March 3, 2014. Accessed January 8, 2013.

Revision Information

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