Hypercalcemia

Hypercalcemia
By:
Jessa Ejercito
Marycris Pagapula-an
 Description of the dse
• Calcium is a mineral that is important in the regulation and
processes of many body functions including bone formation,
hormone release, muscle contraction, and nerve and brain
function. Hypercalcemia is the term that refers to elevated
levels of calcium in the bloodstream.
• Regulation of Calcium
• Calcium levels are tightly regulated in the body. Calcium
regulation is primarily controlled by parathyroid
hormone( PTH), vitamin D, and calcitonin.
• • Parathyroid hormone is a hormone produced by the parathyroid
glands, which are four small glands that surround thethyroid and
are found in the anterior part of the lower neck.
• • Vitamin D is obtained through a process that begins with sun
exposure to the skin, the process then continues in thel i ver and
kidneys. Vitamin D can also be found in foods such as eggs and
dairy products.
• • Calcitonin is produced in specialized cells in the thyroid gland.
Together, these three hormones act on the bones, the kidneys,
and the GI tract to regulate calcium levels in the bloodstream.
 Causes of hypercalcemia
• One of the most common causes of high calcium levels
(hypercalcemia), is an overproduction of parathyroid hormone, or
hyperparathyroidism.
• Hyperparathyroidism occurs in 25 out of every 100,000 persons
and tends to be more common in women.
• It can be the result of all four parathyroid glands producing too
much PTH (parathyroid hyperplasia), and specifically producing an
excessive amount of hormone (usually the result of a parathyroid
adenoma, or benign tumor).
• Cancers, especially lung cancer and breast cancer
• Immobilization over a long period of time
• Kidney failure
• Overactive thyroid (hyperthyroidism) or excessive thyroid
hormone intake
• Use of certain medications such as the thiazide diuretics
• Inherited kidney or metabolic conditions
• Excessive vitamin D levels from vitamins, excessive dietary calcium,
or from diseases that may result in excess vitamin D production.
 Signs and symptoms
Cardiovascular Manifestation Neuromuscular Manifestations
• Increased heart rate (early phase) • Disorientation, lethargy, coma,
• Increased blood volume • Profound muscle weakness
• Bounding, full peripheral pulses • Diminished or absent deep
• Electrocardiographic abnormalities tendon reflexes
• Shortened ST segment Renal Manifestations
• Widened T wave • Increase urine output
• Potentiation of Digoxin-associated • Dehydration
toxicities • Formation of renal calculi
• Decreased clotting time Gastrointestinal
• (late phase) Manifestations
• Bradycardia • Decreased motility
• Cardiac arrest, sinus arrest • Hypoactive bowel sounds
Respiratory Manifestations • Anorexia, nausea
• Ineffective respiratory movement • Abdominal distention
related to profound skeletal • Constipation
muscle weakness • Abdominal pain
 How is it diagnosed?
• Hypercalcemia is easily diagnosed with a
blood test. Diagnosing the causes of
hypercalcemia, however, is a more involved
process; in addition to a detailed history
and physical examination, it may require
further blood tests (such as a PTH level
and vitamin D level), urine evaluation, X-
rays, and other imaging procedures
(electrocardiogram).
Medical
Medical Treatment
Treatment
 GENERIC NAME: indomethacin
BRAND NAME: Indocin, Indocin-SR

• DRUG CLASS AND MECHANISM: Indomethacin is

a nonsteroidal anti-inflammatory drug(NSAID) that
reduces fever, pain and inflammation. It is similar
to ibuprofen (Motrin) and naproxen (Naprosyn, Aleve).
Indomethacin works by reducing the production of
prostaglandins. Prostaglandins are chemicals that the body
produces to cause fever and pain that are associated with
inflammation. Indomethacin blocks the enzymes that make
prostaglandins (cyclooxygenase 1 and 2) and thereby reduces the
levels of prostaglandins. As a result, fever, pain and
inflammation are reduced. Indomethacin is available in a
sustained (slow) release form (Indocin-SR). The FDA first
approved indomethacin in January 1965.

DOSING: The recommended dose for adults is 50-200 mg per

day split into 2-3 doses. Indomethacin should be taken with food
in order to reduce abdominal discomfort.
 GENERIC NAME: calcitonin-salmon
BRAND NAME: Miacalcin, Fortical (Calcimar brand no longer
available)

• DRUG CLASS: Calcitonin-salmon is a man-made version of the

hormone, calcitonin, that is found in salmon. Calcitonin is used for
treating postmenopausal (after menopause)osteoporosis (bone
loss), Paget's disease of bone, and hypercalcemia (high blood
calcium levels). In humans, calcitonin is produced by the thyroid
gland. It acts primarily on bone, but the mechanism of its action is
not well understood. Bone is in a constant state of remodeling,
whereby old bone is removed by cells called osteoclasts, and new
bone is laid down by cells called osteoblasts. Calcitonin inhibits
bone removal by osteoclasts, and promotes bone formation by
osteoblasts.

• DOSING: Injectable calcitonin is injected under the skin or into

the muscle. The nasal spray is administered into the nostril. To
achieve optimal results, patients with osteoporosis should
simultaneously receive adequate amounts of calcium and vitamin D.
 Generic Name: furosemide (fur OH se mide)
Brand Names: Lasix
• Lasix is a loop diuretic (water pill) that prevents your body from
absorbing too much salt, allowing the salt to instead be passed in
your urine.
• Lasix treats fluid retention (edema) in people with congestive heart
failure, liver disease, or a kidney disorder such as nephrotic
syndrome. This medication is also used to treat high blood pressure
(hypertension).
• Lasix may also be used for other purposes not listed in this
medication guide.

Generic Name: plicamycin (plih CA my sin)

Brand Names: Mithracin
• Plicamycin is a cancer (antineoplastic) medication. Plicamycin
interferes with the growth of cancer cells and slows their growth
and spread in the body.
• Plicamycin is used to treat cancer of the testicles. Plicamycin is also
used in the treatment of treat too much calcium in the blood
(hypercalcemia) and too much calcium in the urine (hypercalciuria)
associated with a variety of advanced forms of cancer.
• Plicamycin may also be used for purposes other than those listed in
this medication guide.
 Dietary Management
• You can avoid hypercalcemia from calcium and vitamin D
supplements by contacting your health care provider
for advice if you are taking supplements without a
prescription.

Nursing Diagnosis
• Risk for injury R/T bone demineralization and confusion
• Imbalanced Nutrition: less than body requirements R/T
nausea, vomiting, anorexia secondary to the
hypercalcemia and acute renal failure
• Impaired Physical Mobility R/T decreased muscle tone
secondary to the hypercalcemia
• Risk for Trauma R/T risk for skeletal fractures, bone
changes, muscle weakness secondary to the
hypercalcemia and electrolyte imbalances of the acute
renal failure
• Altered elimination pattern R/T decrease motility
•
Nursing Interventions
Monitor input and output
• Monitor trends in serum levels of calcium (e.g. iodized calcium) as available.
• Monitor fluid overload resulting from hydration therapy (e.g. daily weight, urine
output, jugular vien distention, lung sounds, and right artial pressure), as
appropriate.
• Monitor for neuromuscular manifectations of hypercalcemia (e.g. weakness,
malaise, parathesis, myalgia, hypotonia, decreased deep tendon reflexes, and
poor coordination)
• Encourage mobilization to prevent bone resorption.
• Monitor for recurring hypercalcemia 1 to 3 days after cessation of therapeutic
measures.
• Encourage early ambulation as soon as possible and as frequently as allowed,
being sure to handle the patient carefully to prevent fractures.
• Reposition bedridden patients frequently, and encourage range- of- motion
exercises to promote circulation and prevent urinary stasis, as well as calcium
loss from bone.
• Choose fluids containing sodium, unless contraindicated.
• Discouraged a high intake of calcium-rich foods and fluids, and provide
adequate bulk in the diet to help prevent constipation.
• If confusion or other mental symptoms occur, institute safety precautions as
necessary. Orient the patient frequently, and design a safe environment to
prevent falls.