From the Guidelines
The mnemonic "Stones, Bones, Groans, Psychiatric Overtones" is the most effective way to remember the main symptoms of hypercalcemia. This mnemonic helps recall that hypercalcemia can cause kidney stones ("stones"), bone pain and fractures ("bones"), abdominal pain, nausea, vomiting, and constipation ("groans"), and psychiatric symptoms like depression, anxiety, and confusion ("psychiatric overtones") 1. Some clinicians add "thrones" to represent frequent urination. These symptoms occur because elevated calcium levels affect multiple body systems, including renal function, bone metabolism, gastrointestinal tract, and neurological function. Calcium plays a crucial role in nerve conduction and muscle contraction, so abnormal levels disrupt normal physiological processes. Early recognition of these symptoms is important for prompt diagnosis and treatment of hypercalcemia, which may be caused by primary hyperparathyroidism, malignancy, or other conditions.
Key points to consider when remembering the symptoms of hypercalcemia include:
- Kidney stones and renal dysfunction
- Bone pain and fractures
- Gastrointestinal disturbances such as abdominal pain, nausea, vomiting, and constipation
- Psychiatric symptoms like depression, anxiety, and confusion
- Frequent urination, which can be represented by adding "thrones" to the mnemonic.
It is essential to note that the treatment of hypercalcemia involves hydration, bisphosphonates, denosumab, steroids, and/or calcitonin, with zoledronic acid being the preferred bisphosphonate according to the NCCN MM Panel members 1.
From the Research
Mnemonic to Remember Main Symptoms of Hypercalcemia
There are no specific mnemonics mentioned in the provided studies to remember the main symptoms of hypercalcemia. However, the symptoms of hypercalcemia can be recalled based on the common presentations of the condition:
- Bones: Bone pain, osteitis fibrosa cystica
- Stones: Kidney stones
- Moans: Abdominal pain, constipation
- Groans: Muscle weakness, fatigue
- Psychiatric overtones: Depression, anxiety, altered mental status
- Thrones: Polyuria, polydipsia
These symptoms are commonly associated with hypercalcemia, but it's essential to note that not all patients will exhibit all of these symptoms 2, 3, 4, 5, 6.