From the Guidelines
A patient with hypercalcemia and a history of kidney stones would likely experience additional symptoms including fatigue, muscle weakness, constipation, nausea, vomiting, increased thirst, frequent urination, bone pain, and cognitive changes such as confusion or difficulty concentrating. These symptoms occur because elevated calcium levels affect multiple body systems, as noted in the context of multiple myeloma treatment 1. Neurologically, hypercalcemia can impair nerve function leading to confusion and lethargy. Gastrointestinally, high calcium levels slow gut motility causing constipation and can trigger nausea. The kidneys attempt to excrete excess calcium, resulting in polyuria (increased urination) which leads to dehydration and subsequent polydipsia (increased thirst). Musculoskeletal symptoms arise as calcium is inappropriately mobilized from bones. Some key points to consider in this patient's presentation include:
- The presence of hypercalcemia, which can be due to various causes including hyperparathyroidism, malignancies, or excessive vitamin D intake, as suggested by the need to treat hypercalcemia with hydration, bisphosphonates, denosumab, steroids, and/or calcitonin 1.
- The history of kidney stones, which can be a complication of hypercalcemia due to the increased calcium load in the urine.
- The potential for dehydration and electrolyte imbalances, which can exacerbate symptoms and complicate treatment. Given the potential severity of hypercalcemia, prompt treatment is essential to prevent complications such as cardiac arrhythmias, seizures, and coma. The treatment approach may involve addressing the underlying cause of hypercalcemia, as well as managing symptoms and preventing further complications, as outlined in guidelines for managing hypercalcemia in the context of multiple myeloma 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 This, in turn, results in increased renal resorption of calcium, setting up a cycle of worsening systemic hypercalcemia.
A patient with hypercalcemia and a history of kidney stones may experience:
- Polyuria: excessive urine production
- Gastrointestinal disturbances: nausea, vomiting, abdominal pain
- Dehydration: due to excessive urine production and gastrointestinal disturbances
- Decreased glomerular filtration rate: leading to worsening hypercalcemia
- Kidney stone recurrence: due to increased calcium levels in the urine Additionally, hypercalcemia can cause:
- Neurological symptoms: confusion, weakness, fatigue
- Cardiovascular symptoms: arrhythmias, hypertension
- Musculoskeletal symptoms: bone pain, muscle weakness 2
From the Research
Hypercalcemia Symptoms
The patient with a serum calcium level of 13.2 and a history of kidney stones is likely to experience symptoms related to hypercalcemia. These symptoms may include:
- Fatigue
- Weakness
- Confusion
- Nausea and vomiting
- Abdominal cramps
- Constipation
- Polyuria (frequent urination)
- Polydipsia (excessive thirst)
Additional Symptoms
In addition to these general symptoms of hypercalcemia, the patient may also experience:
- Bone pain
- Muscle weakness
- Neurological symptoms such as depression, anxiety, and cognitive impairment
- Cardiovascular symptoms such as shortened QT interval and arrhythmias
Relationship to Kidney Stones
The patient's history of kidney stones is relevant, as hypercalcemia can increase the risk of developing kidney stones 3. The high calcium levels can cause an increase in calcium excretion in the urine, leading to the formation of calcium stones.
Treatment-Related Symptoms
If the patient is treated with bisphosphonates, they may experience additional symptoms such as:
Note: The symptoms listed above are based on the provided evidence and may not be an exhaustive list of all possible symptoms.