What Exactly is Hypercalcemia?

Hypercalcemia, sometimes called hypercalcemia, is characterized by high calcium (Ca2+) concentration in the blood serum. When measured in milligrams per deciliter (8.8–10.7 mg/dL), the normal range is 2.1–2.6 mmol/L, with results more than 2.6 mmol/L categorized as hypercalcemia. Calcium is required for the regular operation of organs, cells, muscles, and nerves. It also has a role in blood coagulation and bone health. On the other hand, too much of it may be problematic. Hypercalcemia makes it difficult for the body to carry out its usual tasks. Extremely high calcium levels may be life-threatening.

Hypercalcemia has a number of different causes.

Hypercalcemia may be compelled by a number of factors, including the following:

• Hyperparathyroidism is a condition in which one or more of the four parathyroid glands releases excessive amounts of parathyroid hormone, which aids in regulating the quantity of calcium in the blood.

• In certain cases, hypercalcemia may occur in people with peptic ulcers who consume a lot of milk and use calcium-containing antacids for pain relief. The ensuing disease is referred to as the milk-alkali syndrome.

• Excessive vitamin D intake: If individuals consume exceedingly high daily doses of vitamin D for a prolonged period of time, the quantity of calcium absorbed from the digestive system rises significantly.

• Cells in kidney, lung, and ovarian tumors may emit high quantities of a protein that, like a parathyroid hormone, raises the calcium level in the blood. These adverse effects, known as humoral hypercalcemia of malignancy, are referred to as the paraneoplastic syndrome. Calcium may also be released into the bloodstream when cancer expands (metastasizes) to the bone and kills bone cells. Prostate, lung, and breast cancers are the most prevalent tumors that cause bone damage. Multiple myeloma (a malignancy of the bone marrow) may also result in the breakdown of bone and the development of hypercalcemia. Other malignancies, which are not yet completely known, have the ability to raise the calcium level in the blood.

• Bone disorders: When bone is broken down (resorbed) or damaged, calcium is secreted into the bloodstream, resulting in hypercalcemia in certain cases. Paget disease is characterized by bone breakdown, yet the calcium level in the blood is often normal. However, in people with Paget disease who get dehydrated or who spend an excessive amount of time sitting or laying down—when the bones are not bearing weight—the calcium level may become dangerously high. Severe hyperthyroidism may also lead to hypercalcemia by accelerating the resorption of bone tissue.

• Inactivity: Individuals who are incapacitated for extended periods of time, like those who are paralyzed or those who must remain in bed for a longer duration, may develop hypercalcemia because when the bones are not bearing weight for a long length of time, calcium from the bones is released into the bloodstream.

• Hypercalcemia may be caused by granulomatous illnesses, medications, endocrine problems, and a variety of other conditions.

What are the Signs and Symptoms of Hypercalcemia?

If you have moderate hypercalcemia, you may not notice any outward signs or symptoms. If you have a more severe case, you will often have signs and symptoms that impact different sections of your body.

• Tiredness

• Constipation

• Profuse urination

• A reduction in appetite

• vomiting or throwing up

• Soreness in your back and upper abdomen on one side of your body as a result of kidney stones

• Nausea

• Excessive hydration

• Bloating, gas, or indigestion.

• Headaches

• High calcium levels may have an effect on the electrical system of the heart, resulting in irregular cardiac rhythms.

High calcium levels may have negative consequences for the bones, resulting in:

• Osteoporosis

• High calcium levels may have an effect on your muscles, producing spasms, cramps, and weakness.

• Fractures resulting from illness

• Bone soreness is a common complaint.

Symptoms of the Nervous System

Hypercalcemia may also produce neurological symptoms such as depression, memory loss, and irritability. Severe instances might result in disorientation and unconsciousness.

If you currently have cancer and are experiencing any of the signs of hypercalcemia, contact your doctor immediately. It is fairly unusual for cancer to induce high calcium levels in the blood. An emergency medical situation is created when this occurs.

A Diagnostic Approach to Hypercalcemia

Hypercalcemia is a clinical condition that affects a significant number of people. Primary hyperparathyroidism and malignancy are the most prevalent causes of hypercalcemia, accounting for more than 90% of all cases. As a result, the diagnostic approach to hypercalcemia is often based on differentiating between the two.

It is usually not difficult to distinguish between them. In most cases, malignancy is clinically obvious by the time it produces hypercalcemia, and patients with malignant hypercalcemia often have greater calcium concentrations and are more symptomatic as a result of hypercalcemia than people with primary hyperparathyroidism. Even though primary hyperparathyroidism is the most ordinary cause of hypercalcemia in healthy outpatients, malignancy is the most common cause of hypercalcemia in hospitalized patients. Other potential causes of hypercalcemia must be considered as well.

Verify Hypercalcemia

The very first step in the examination of a patient with hypercalcemia is to confirm with a repeat test (total calcium adjusted for albumin) that there is a real rise in the blood calcium concentration. Previous serum calcium levels should be checked as well if they are available. The existence of long-standing asymptomatic hypercalcemia is more indicative of primary hyperparathyroidism, and it also increases the potential for familial hypocalciuric hypercalcemia, which is a far less frequent condition.

The presence or absence of hypercalcemia may also be relevant in diagnosing the condition. Primary hyperparathyroidism is often linked with borderline or moderate hypercalcemia (serum calcium concentrations that are less than 11 mg/dL [2.75 mmol/L]). Values greater than 13 mg/dL (3.25 mmol/L) are uncommon in primary hyperparathyroidism. While they do occur, nevertheless, they are more prevalent in individuals with malignancy-associated hypercalcemia.

 Treatment for Hypercalcemia

If your hypercalcemia is minor, you and your physician may decide to watch and wait, closely evaluating the condition of your bones and kidneys over time.

If your hypercalcemia is more severe, your doctor may prescribe medication or treatment for the underlying illness, which may include surgery.

Medications

In certain instances, your physician may recommend

• Calcimimetics. This class of medication may aid in the regulation of hyperactive parathyroid glands. Cinacalcet (Sensipar) is authorized for the treatment of hypercalcemia.

• Prednisone If the reason for your hypercalcemia is excessive vitamin D, quick usage of steroid tablets such as prednisone is typically beneficial.

• Intravenous fluids and diuretics Calcium levels that are abnormally high might be a life-threatening issue. You may need hospitalization for therapy with intravenous fluids and diuretics to rapidly decrease the calcium level and avoid heart rhythm difficulties or nervous system damage.

• Intravenous bisphosphonates: Intravenous osteoporosis medications are often used to cure hypercalcemia caused by malignancy. The risks of this therapy include the collapse of the jaw (osteonecrosis) and some forms of thigh fractures.

• Denosumab (Prolia, Xgeva): This medication is frequently used to treat patients with hypercalcemia caused by cancer that does not react well to bisphosphonates.

• Calcitonin Miacalcin: This salmon hormone regulates blood calcium levels. Mild nausea is a possible adverse effect.

Surgical and Other Interventions

Often, problems connected with hyperactive parathyroid glands may be resolved with surgery to remove the abnormal tissue. Often, just one of an individual’s four parathyroid glands is damaged. A specialized scanning test employs a modest dosage of radioactive material to detect the gland or glands that are malfunctioning.

Home Care for Hypercalcemia

• Speak with your healthcare professional about how much liquid you should consume. Every day, the vast majority of persons with hypercalcemia must consume 3 quarts to 1 gallon (3 to 4 liters) of liquids or as directed by their healthcare provider.
• Keep track of how much liquid you consume.

• Fill a gallon milk jug with water that has been cleaned and rinsed, or purchase a gallon of water and store it in your refrigerator. Drink the entire jug of water throughout the day or as directed by your healthcare provider.

• Eat fewer foods that are rich in calcium. Significantly reduce or eliminate your consumption of dairy products such as milk, cheese, cottage cheese, yogurt, pudding, and ice cream. Be sure to read the labels on the food you eat. Avoid purchasing dairy products that have extra calcium. Orange juice that has been calcium-fortified. Ready-to-eat cereals with calcium added Cans of salmon or sardines with fragile bones

• Avoid using antacid medications if they have calcium as a component. Calcium is found in several antacids. Some include magnesium but no calcium.

• Don’t restrict your salt consumption.

• If you have hypercalcemia as a result of prolonged bed rest, attempt to increase your physical activity as much as possible.

• Return to your usual activities as suggested by your healthcare professional.

• Follow the directions on your prescription medications precisely.

• Inform your healthcare practitioner of any other medications you are taking, including over-the-counter or herbal medications and supplements.
• Keep all appointments for lab tests and follow-up care. Your medical practitioner will need to keep a careful eye on your situation.