Hypercalcemia: Causes, Symptoms, Diagnosis, Management, Complications, Prevention, and Monitoring for Effective Patient Care

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Definition and Causes

Hypercalcemia refers to elevated levels of calcium in the blood (>10.5 mg/dL or >2.6 mmol/L). 

Common causes include:


Primary hyperparathyroidism (most common in ambulatory patients).

Malignancy-associated hypercalcemia (common in hospitalized patients).

Vitamin D intoxication, prolonged immobilization, or medications (e.g., thiazides, lithium).


Clinical Features

Symptoms range from mild to severe and are summarized as "stones, bones, moans, and groans":


Renal: Polyuria, nephrolithiasis, nephrocalcinosis.


Skeletal: Bone pain, fractures.


Gastrointestinal: Nausea, vomiting, constipation, abdominal pain.


Neurological: Fatigue, confusion, depression, or coma in severe cases.


Diagnosis


Initial tests: Serum calcium (corrected for albumin), ionized calcium, PTH, vitamin D levels.


Further evaluation: Parathyroid hormone-related protein (PTHrP), imaging for malignancy, or granulomatous diseases (e.g., sarcoidosis).


Management


Acute/severe cases:

Intravenous fluids (normal saline) to restore hydration.

Loop diuretics (e.g., furosemide) after rehydration to enhance calcium excretion.

Bisphosphonates or calcitonin to reduce bone resorption.

Chronic management: Treat underlying cause (e.g., surg

ery for parathyroid adenoma, adjust medications).


Complications

Cardiovascular: Arrhythmias, hypertension.

Renal: Chronic kidney disease, nephrocalcinosis.

Skeletal: Osteoporosis, fractures.

Neurological: Permanent cognitive impairment if untreated.


Prevention and Monitoring


Preventing hypercalcemia involves addressing underlying risk factors, such as avoiding excessive calcium or vitamin D supplementation and managing conditions like hyperparathyroidism early. 


Regular monitoring of serum calcium and renal function is essential in at-risk patients, especially those with a history of hypercalcemia, malignancies, or chronic kidney disease. Lifestyle measures, including adequate hydration and physical activity, can also help reduce the risk of complications.


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