Hypercalcaemia

Hypercalcemia
Other names	Hypercalcaemia
Calcium within the periodic table
Specialty	Endocrinology
Symptoms	Abdominal pain, bone pain, confusion, depression, weakness[1][2]
Complications	Kidney stones, abnormal heart rhythm, cardiac arrest[1][2]
Causes	Primary hyperparathyroidism, cancer, sarcoidosis, tuberculosis, Paget disease, multiple endocrine neoplasia, vitamin D toxicity[1][3]
Diagnostic method	Blood serum level > 2.6 mmol/L (corrected calcium or ionized calcium)[1][2]
Treatment	Underlying cause, intravenous fluids, furosemide, calcitonin, pamidronate, hemodialysis[1][2]
Medication	See article
Frequency	4 per 1,000[1]

Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca²⁺) level in the blood serum.^[1][3] The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia.^[1][2][4] Those with a mild increase that has developed slowly typically have no symptoms.^[1] In those with greater levels or rapid onset, symptoms may include abdominal pain, bone pain, confusion, depression, weakness, kidney stones or an abnormal heart rhythm including cardiac arrest.^[1][2]

Most outpatient cases are due to primary hyperparathyroidism and inpatient cases due to cancer.^[1] Other causes of hypercalcemia include sarcoidosis, tuberculosis, Paget disease, multiple endocrine neoplasia (MEN), vitamin D toxicity, familial hypocalciuric hypercalcaemia and certain medications such as lithium and hydrochlorothiazide.^[1][2][3] Diagnosis should generally include either a corrected calcium or ionized calcium level and be confirmed after a week.^[1] Specific changes, such as a shortened QT interval and prolonged PR interval, may be seen on an electrocardiogram (ECG).^[2]

Treatment may include intravenous fluids, furosemide, calcitonin, intravenous bisphosphonate, in addition to treating the underlying cause.^[1][2] The evidence for furosemide use, however, is poor.^[1] In those with very high levels, hospitalization may be required.^[1] Haemodialysis may be used in those who do not respond to other treatments.^[1] In those with vitamin D toxicity, steroids may be useful.^[1] Hypercalcemia is relatively common.^[1] Primary hyperparathyroidism occurs in 1–7 per 1,000 people, and hypercalcaemia occurs in about 2.7% of those with cancer.^[1]