Hypercalcemia

Causes
 Increased intake: Excess IV calcium
 Decreased excretion: renal failure, thiazide diuretics
 Bone breakdown: prolonged immobility, fractures, malignant diseases, Paget’s disease,
hyperparathyroidism, hyperthyroidism, hypophosphatemia
 Increase absorption: Vitamin D or Vitamin A overdose
 Medications: diuretics, ace inhibitors

Signs & Symptoms

weakness, lethargy, nausea, vomiting, anorexia, polyuria ( from nephrogenic diabetes insipidus),
bone pain, fractures, itching, flank pain ( renal calculi), confusion, depression, stupor, coma,
personality changes, paresthesia, ECG findings: shortening of ST segment and QT interval,
prolonged PR interval. more severe: ventricular dysrhythmia. Risk for digitalis toxicity
Tests
 Imaging: assess bone density, identify kidney stones
 Ionized Calcium: elevated
 Parathyroid hormone: increased in hyperparathyroidism
 Serum Calcium: elevated, assess serum albumin level: for every 1g/dL drop in albumin there is
a drop in calcium of 0.8- 1 mg/dL decrease in serum calcium

Treatment
Treat underlying cause: partial parathyroidectomy for hyperparathyroidism, chemotherapy for
malignant disease, or discontinue ca supplements, vitamin A, vitamin D, thiazide diuretics in renal
patients.

IV NS solution: Administer rapidly to increased Ca excretion via urine. Administer diuretics at the
same time to prevent volume overload and to increase calcium excretion.

Low calcium diet: limit calcium intake.

Hemodialysis: with low calcium dialysate in renal failure patients.

 Bisphosphates: Pamidronate or etidronate: These medications inhibit bone resorption. This
medication is most often used for malignant disease
 Plicamycin: cytotoxic antibiotics that decreases bone resorption. Used with neoplastic
disorders.
 Calcitonin: Reduces bone resorption and increase bone deposition of Ca and phos. increase
urinary ca and phosphorus excretion.
 Gallium nitrate: inhibit bone resorption – used in malignant disease.
 Cortisone: Steroids compete with Vitamin D for absorption in the small intestines. This
decreases calcium absorption as well.