What are the symptoms of hypercalcaemia (elevated calcium levels)?

From the Guidelines

Hypercalcemia typically presents with symptoms such as polyuria, gastrointestinal disturbances, progressive dehydration, and decreases in glomerular filtration rate, as a result of excess bone resorption from bone disease leading to excessive release of calcium into the blood. These symptoms can be remembered by the phrase "stones, bones, abdominal groans, and psychic moans" 1. Common symptoms include:

• Kidney stones
• Bone pain
• Abdominal pain
• Constipation
• Nausea
• Vomiting
• Increased urination (polyuria)
• Excessive thirst (polydipsia)
• Fatigue
• Weakness
• Confusion
• Depression
• Cognitive impairment In severe cases, patients may experience cardiac arrhythmias, coma, or even death 1. The severity of symptoms typically correlates with both the calcium level and how rapidly it rises. Mild hypercalcemia (calcium levels below 12 mg/dL) may be asymptomatic and discovered incidentally on routine blood tests. These symptoms occur because calcium affects multiple body systems, including nerve and muscle function, gastrointestinal motility, kidney function, and bone metabolism.

The most recent and highest quality study, published in 2020, provides guidance on the treatment of hypercalcemia, which may include hydration, bisphosphonates, denosumab, steroids, and/or calcitonin 1. Among the bisphosphonates, zoledronic acid is preferred for the treatment of hypercalcemia 1. It is essential to note that the symptoms of hypercalcemia can be similar to those of other conditions, such as primary hyperparathyroidism or malignancy, and a thorough diagnosis is necessary to determine the underlying cause 1.

In clinical practice, it is crucial to consider the potential causes of hypercalcemia and to evaluate the patient's overall condition, including the presence of any underlying diseases or conditions that may be contributing to the hypercalcemia 1. The treatment of hypercalcemia should be tailored to the individual patient's needs, taking into account the severity of symptoms, the underlying cause, and any potential comorbidities 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 The symptoms of hypercalcaemia (elevated calcium levels) include:

• Polyuria (excessive urine production)
• Gastrointestinal disturbances
• Progressive dehydration
• Decreasing glomerular filtration rate 2 3

From the Research

Symptoms of Hypercalcaemia

The symptoms of hypercalcaemia can vary depending on the severity of the condition.

• Mild hypercalcaemia is usually asymptomatic, but may be associated with constitutional symptoms such as:
  • Fatigue 4
  • Constipation 4
• Severe hypercalcaemia can cause:
  • Nausea 4, 5, 6, 7
  • Vomiting 4, 5, 6, 7
  • Dehydration 4, 5, 6
  • Confusion 4, 6, 7
  • Somnolence 4
  • Coma 4
  • Abdominal pain 7
  • Excessive thirst 7
  • Muscle weakness 7
  • Lethargy 7
  • Fatigue 7

Causes of Hypercalcaemia

Hypercalcaemia can be caused by various conditions, including:

• Primary hyperparathyroidism (PHPT) 4, 5, 8
• Malignancy 4, 5, 8
• Granulomatous disease such as sarcoidosis 4, 8
• Endocrinopathies such as thyroid disease 4
• Immobilization 4
• Genetic disorders 4
• Medications such as thiazide diuretics and supplements such as calcium, vitamin D, or vitamin A 4, 7