From the Guidelines
Hypercalcemia presents with a range of clinical manifestations that affect multiple body systems, including fatigue, weakness, confusion, memory problems, depression, constipation, increased thirst, frequent urination, nausea, vomiting, and abdominal pain, as noted in the most recent guidelines 1.
Clinical Manifestations
The symptoms of hypercalcemia can be remembered using the classic mnemonic "stones, bones, abdominal groans, and psychic moans". These symptoms occur because calcium plays crucial roles in neuromuscular function, cardiac conduction, bone metabolism, and kidney function. Elevated calcium disrupts these normal physiological processes, leading to impaired nerve conduction, muscle weakness, altered mental status, and kidney dysfunction through decreased concentrating ability and calcium deposition in renal tissue.
Severity of Symptoms
The severity of symptoms generally correlates with both the calcium level and how rapidly it rises. Mild hypercalcemia (calcium levels below 12 mg/dL) may be asymptomatic, while severe hypercalcemia (above 14 mg/dL) can lead to life-threatening complications including coma and cardiac arrest, as discussed in the guidelines 1.
Treatment
Treatment of hypercalcemia should focus on addressing the underlying cause, as well as managing symptoms and preventing further complications. According to the guidelines, treatment may include hydration, bisphosphonates, denosumab, steroids, and/or calcitonin 1.
Key Considerations
It is essential to note that hypercalcemia can have significant morbidity and mortality implications if left untreated or undertreated. Therefore, prompt recognition and management of hypercalcemia are crucial to improve patient outcomes, as emphasized in the guidelines 1.
From the FDA Drug Label
Excessive release of calcium into the blood as bone is resorbed results in polyuria and gastrointestinal disturbances, with progressive dehydration and decreasing glomerular filtration rate
- Clinical manifestations of hypercalcemia include:
- Polyuria
- Gastrointestinal disturbances
- Progressive dehydration
- Decreasing glomerular filtration rate 2
From the Research
Clinical Manifestations of Hypercalcemia
The clinical manifestations of hypercalcemia can vary depending on the severity of the condition.
- Mild hypercalcemia is usually asymptomatic, but may be associated with constitutional symptoms such as fatigue and constipation in approximately 20% of people 3.
- Severe hypercalcemia can cause nausea, vomiting, dehydration, confusion, somnolence, and coma 3, 4.
- Hypercalcemia can also be associated with primary hyperparathyroidism (PHPT) or malignancy, with approximately 90% of people with hypercalcemia having one of these two conditions 3.
Symptoms of Hypercalcemia
The symptoms of hypercalcemia can include:
- Nausea and vomiting
- Dehydration
- Confusion
- Somnolence
- Coma
- Fatigue
- Constipation
Treatment of Hypercalcemia
The treatment of hypercalcemia depends on the underlying cause and severity of the condition.
- Mild hypercalcemia usually does not need acute intervention, but may be managed with parathyroidectomy or observation with monitoring 3.
- Severe hypercalcemia is typically treated with hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate 3, 4, 5, 6, 7.
- Glucocorticoids may be used as primary treatment when hypercalcemia is due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas) 3.