From the Guidelines
Hypercalcemia presents with symptoms that reflect calcium's widespread effects throughout the body, including polyuria, gastrointestinal disturbances, progressive dehydration, and decreases in glomerular filtration rate, as noted in the most recent study 1.
Symptoms of Hypercalcemia
The symptoms of hypercalcemia can be diverse and affect various systems in the body. Common symptoms include:
- Fatigue
- Weakness
- Confusion
- Memory problems
- Depression
- Constipation
- Increased thirst
- Frequent urination
- Nausea
- Vomiting
- Loss of appetite
- Bone pain
- Muscle weakness or twitching In severe cases, patients may experience kidney stones, abnormal heart rhythms, or even coma. The severity of symptoms typically correlates with both the calcium level and how quickly it rises. Mild hypercalcemia (calcium levels below 12 mg/dL) may be asymptomatic, while moderate to severe elevations often cause the classic "bones, stones, abdominal groans, and psychic moans" presentation.
Importance of Prompt Medical Attention
Hypercalcemia requires prompt medical attention as untreated severe cases can lead to kidney failure, cardiac arrhythmias, and altered mental status. The underlying cause, commonly hyperparathyroidism or malignancy, must be identified and addressed to effectively manage the condition. According to the study 1, excess bone resorption from bone disease can lead to excessive release of calcium into the blood, contributing to hypercalcemia.
Treatment and Management
Treatment of hypercalcemia should focus on hydration, bisphosphonates, denosumab, steroids, and/or calcitonin, as recommended by the NCCN MM Panel members 1. Among the bisphosphonates, zoledronic acid is preferred for the treatment of hypercalcemia. It is essential to identify and address the underlying cause of hypercalcemia to effectively manage the condition and prevent complications.
From the Research
Symptoms of Hypercalcemia
The symptoms of hypercalcemia can vary depending on the severity of the condition. Some common symptoms include:
- Fatigue
- Constipation
- Nausea
- Vomiting
- Dehydration
- Confusion
- Somnolence
- Coma 2, 3, 4, 5 In mild cases of hypercalcemia, patients may be asymptomatic, while severe cases can lead to more pronounced symptoms 3, 4.
Severity of Hypercalcemia and Symptoms
The severity of hypercalcemia is classified into mild, moderate, and severe, depending on calcium values.
- Mild hypercalcemia is usually asymptomatic but may be associated with constitutional symptoms such as fatigue and constipation in approximately 20% of people 2.
- Severe hypercalcemia can cause nausea, vomiting, dehydration, confusion, somnolence, and coma 2, 3, 4, 5. The clinical manifestations of hypercalcemia are related to calcium levels, with higher values leading to more pronounced symptoms 3.
Hypercalcemia in Cancer Patients
Hypercalcemia of malignancy is estimated to affect over 40% of cancer patients and can be associated with both solid and blood cancers 6.