hypercalcemia, High Blood Calcium, Causes, Symptoms And Treatment!  

hypercalcemia

Understanding High Blood Calcium Hypercalcemia:

Hypercalcemia:

People with high blood calcium also called hypercalcemia, have above-normal levels of calcium in their blood. Hormone problems are some of the many possible causes of high blood calcium. Calcium is a mineral found mostly in your bones, where it builds and maintains bone strength. A small amount of calcium is also found in muscle and blood cells, hypercalcemia

where it plays several important roles it helps: 

• Muscles contract.
• Nerves and the brain work properly,
• Regulate (control) your heart rhythm and blood pressure.

 

High blood calcium often does not cause any symptoms. But over time, some causes of high blood calcium can lead to osteoporosis (thinning of the bones) and kidney stones. Very high blood calcium can cause more serious problems, including kidney failure, abnormal heart rhythm, mental confusion, and even coma.

Calcium Levels in The Blood:

Calcium enters the blood in different ways. The level of calcium in the blood is controlled by hormones and the kidneys. Calcitriol is a hormone form of vitamin D. It helps the intestines take up calcium from foods and drinks. The intestines then release calcium into the blood.

Parathyroid hormone (PTH) helps control the level of calcium in the blood. When blood calcium levels are low, the parathyroid gland releases PTH. PTH stimulates cells in the bones to break bone down and release calcium into the blood. It also tells the kidneys and intestines to absorb more calcium.

The kidneys help control the amount of calcium in the body. They can remove large amounts of calcium from the blood and pass it into the urine.

Causes?

Everybody needs calcium for many body functions. It helps form bones and teeth, and it also helps your muscles, nerves, and brain work correctly. Most of the calcium in your body is in your bones. Normally, your blood contains only a small amount. When you are healthy, your body controls the level of calcium in your blood.

• The most common cause of high blood calcium is a condition called primary hyperparathyroidism or PHPT.
• In this condition, one or more of the parathyroid glands produce too much PTH.
• This, in turn, causes the bones to release too much calcium into the blood.
• Women over the age of 50 are more likely than others to have PHPT.

Certain types of cancer, most often:

• Breast cancer.
• Lung cancer, or multiple myeloma (a type of blood cancer), can also cause high blood calcium.
• This usually occurs late in the course of cancer.
• Leukemia.
• Kidney cancer.

Less common causes of hypercalcemia include these health problems:

• Infectious diseases, such as tuberculosis.
• Autoimmune diseases, such as sarcoidosis.
• Hormone disorders, such as overactive thyroid (hyperthyroidism).
• A genetic condition called familial hypocalciuric hypercalcemia.
  Kidney failure.

 

Other infrequent causes of high blood calcium include:

• Medicines, such as lithium (to treat psychiatric illness) or, rarely, thiazide diuretics.
• Intake of very large amounts of calcium or large amounts of milk plus antacids.
• And the intake of too much vitamin D or vitamin A.
• Immobility being confined to bed for at least several weeks combined with some bone diseases, such as Paget’s disease.
• Tube feeding or being fed through a vein.
• Severe dehydration.

Symptoms of High Blood Calcium:

You might not have signs or symptoms if your hypercalcemia is mild. More-severe cases produce signs and symptoms related to the parts of your body affected by the high calcium levels in your blood, Symptoms of hypercalcemia can vary and may get worse as hypercalcemia progresses.

Symptoms of hypercalcemia include:

• Nausea.
• Vomiting.
• Loss of appetite, or anorexia.
• Constipation.
• Fatigue.
• Muscle weakness.
• Increased thirst.
• Frequent and increased urination.
• Dark yellow urine.
• Little or no sweating.
• Abnormal heart rhythm.
• Weaker muscle reflexes.
• Confusion and difficulty thinking clearly or concentrating.
• Mental or physical sluggishness, or lethargy.
• Coma.
• Kidney stones.
• Bone pain or bone fracture.

Risk Factors:

Women older than 50 are at the highest risk of overactive parathyroid glands.

Complications:

Complications are unlikely since hypercalcemia is easy to detect. However, if not detected and treated, the following health effects could occur:

• Osteoporosis and bone fractures.
• Kidney stones.
• Hypertension.
• Kidney failure.
• Ulcer.
• Abnormal heart rhythm (arrhythmia).

Diagnosis:

Your doctor will try to find the cause of the hypercalcemia.

• This includes a physical exam, assessing your symptoms and a neurological exam.
• During a neurological exam, your doctor will ask you questions and do tests to check your brain, spinal cord, and nerve function.
• They will also check your mental status and coordination, including how well your muscles, senses, and reflexes work.

Your doctor will also order:

• Blood chemistry tests.
• Urinalysis.
• Kidney function tests.

 

Kidney function tests and urinalysis look for certain substances in the blood and urine to determine how well the kidneys are working.

Treatment of Hypercalcemia:

How is Hypercalcemia treated?

Treatment of hypercalcemia depends on what is causing the disorder and how severe it is. If it is in an early stage and the cause is an overactive parathyroid gland, there are several options:

You May Be:

• Closely monitored by your doctor.
• Given fluids to treat dehydration.
• Prescribed a medication.
• Prescribed medications to control bone loss.
• Hospitalized in severe cases.
• You may need to undergo surgery and have your parathyroid gland removed.

 

The goal of therapy is to treat the hypercalcemia first and subsequently effort is directed to treat the underlying cause.

1. Fluids and diuretics:

Initial therapy:

• hydration, increasing salt intake and forced diuresis.
  • hydration is needed because many patients are dehydrated due to vomiting or kidney defects in concentrating urine.
  • increased salt intake also can increase body fluid volume as well as increased urine sodium excretion, which further increases urinary potassium excretion.
  • after rehydration, a loop diuretic such as furosemide can be given to permit continued large volume intravenous salt and water replacement while minimizing the risk of blood volume overload and pulmonary edema. In addition, loop diuretics tend to depress calcium reabsorption by the kidney thereby helping to lower blood calcium levels.
  • can usually decrease serum calcium by 1–3 mg/dL within 24 hours.
  • caution must be taken to prevent potassium or magnesium depletion.

2. Bisphosphonates and calcitonin:

Additional therapy:

• bisphosphonates are pyrophosphate analogs with high affinity for bone, especially areas of high bone turnover.
  • They are taken up by osteoclasts and inhibit osteoclastic bone resorption.
  • Currently available drugs include (in order of potency):
    • (1st gen) etidronate, (2nd gen) tiludronate, IV pamidronate, alendronate (3rd gen) zoledronate, and risedronate.
  • All people with cancer-associated hypercalcemia should receive treatment with bisphosphonates since the ‘first line’ therapy (above) cannot be continued indefinitely nor is it without risk.
    • Further, even if the ‘first line’ therapy has been effective, it is a virtual certainty that the hypercalcaemia will recur in the person with hypercalcaemia of malignancy.
    • The use of bisphosphonates in such circumstances, then, becomes both therapeutic and preventative.

 

People in kidney failure and hypercalcemia:

• • Should have a risk-benefit analysis before being given bisphosphonates since they are relatively contraindicated in kidney failure.
• Calcitonin blocks bone resorption and also increases urinary calcium excretion by inhibiting calcium reabsorption by the kidney.
  • Usually used in life-threatening hypercalcemia along with rehydration, diuresis, and bisphosphonates.
  • It helps prevent the recurrence of hypercalcemia.
  • The dose is 4 international units per kilogram via subcutaneous or intramuscular route every 12 hours, usually not continued indefinitely due to the quick onset of decreased response to calcitonin.

3. Other therapies:

• Rarely used or used in special circumstances.
  • plicamycin inhibits bone resorption (rarely used).
  • gallium nitrate inhibits bone resorption and changes the structure of bone crystals (rarely used).
  • glucocorticoids increase urinary calcium excretion and decrease intestinal calcium absorption
    • no effect on calcium level in normal or primary hyperparathyroidism
    • effective in hypercalcemia due to osteolytic malignancies (multiple myeloma, leukemia, Hodgkin’s lymphoma, carcinoma of the breast) due to antitumor properties
    • also effective in hypervitaminosis D and sarcoidosis.
  • dialysis usually used in severe hypercalcemia complicated by kidney failure. Supplemental phosphate should be monitored and added if necessary.
  • phosphate therapy can correct the hypophosphatemia in the face of hypercalcemia and lower serum calcium.

Prevention:

Not all hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets are recommended.

• Hypercalcemia usually cannot be prevented. Because of this, it is good to know your family history as well as the symptoms to watch for.
• You should have your calcium levels checked by your doctor.
• Ask your doctor before you take calcium or vitamin D supplements to be sure you really need them.

Tips, Things You Can Do:

• It is important that you stay well hydrated.  Drink 2 to 3 quarts of fluid every 24 hours, unless you are instructed otherwise.
• Take anti-nausea and anti-diarrhea medications as directed, also follow dietary recommendations.
• Keep active, weight-bearing activities such as walking are helpful.  Being immobile aggravates hypercalcemia.

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Disclaimer: “Nothing in this article makes any claim to offer cures or treatment of any disease or illness. If you are sick please consult with your doctor.”

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