From the Guidelines
Hypercalcemia is characterized by symptoms such as polyuria, polydipsia, nausea, confusion, vomiting, abdominal pain, and myalgia, which can progress to severe dehydration, acute renal failure, mental status changes, bradycardia, and hypotension in severe cases.
Signs and Symptoms
- Polyuria
- Polydipsia
- Nausea
- Confusion
- Vomiting
- Abdominal pain
- Myalgia
- Severe dehydration
- Acute renal failure
- Mental status changes
- Bradycardia
- Hypotension These symptoms depend on the severity and acuity of onset of hypercalcemia, as noted in the guidelines for the management of hypercalcemia 1.
Diagnostic Evaluation
The diagnostic evaluation of hypercalcemia includes measuring serum concentrations of intact parathyroid hormone (iPTH), parathyroid hormone-related protein (PTHrP), 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, calcium, albumin, magnesium, and phosphorus 1.
Management
Management of hypercalcemia includes oral hydration for mild cases, and rehydrating with IV crystalloid fluids and loop diuretics for moderate to severe cases 1. Bisphosphonates, such as zoledronic acid, are also effective in treating hypercalcemia, as recommended by the NCCN MM Panel members 2. Additional therapeutic options include glucocorticoids, gallium nitrate, and salmon calcitonin 1.
From the Research
Signs and Symptoms of Hypercalcemia
The signs and symptoms 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.
- Neuropsychiatric symptoms, such as marked asthenia, muscle weakness, and altered mental status, can also occur, especially in children and adolescents 5.
- Other symptoms may include muscle weakness, difficulty walking, and nonsensical speech 5.
Factors Influencing Signs and Symptoms
The signs and symptoms of hypercalcemia can be influenced by several factors, including:
- The severity of hypercalcemia: severe hypercalcemia is more likely to cause symptoms such as nausea, vomiting, and confusion 3, 4.
- The rate of development: hypercalcemia that develops rapidly over days to weeks is more likely to cause symptoms 3.
- The underlying cause: primary hyperparathyroidism and malignancy are the most common causes of hypercalcemia, and may have different symptoms and treatment options 3, 6, 4.
Clinical Manifestations
Hypercalcemia can affect various systems in the body, including: