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Hypercalcemia: Treatment, symptoms, advice and help

About hypercalcemia

Hypercalcemia is a condition in which there is increased level of calcium in the blood. It can occur as a result of several disorders. Identification of hypercalcemia is important in order to prevent acute and chronic complications.

Hypercalcemia: Incidence, age and sex

Hypercalcemia is a relatively uncommon condition. Primary hyperparathyroidism which is the commonest cause of hypercalcemia, has an annual incidence of 4 per 100,000 population and occurs mainly in the age group of 50 to 60 years. Women are affected more frequently than men. Hypercalcemia is an important complication in malignancies and occurs in 5 % of all cancers.

Signs and symptoms of hypercalcemia: Diagnosis

The initial manifestations of hypercalcemia are fatigue, muscular weakness, depression, mild impairment of cognition, dyspepsia, increased urination and increased thirst. As the blood calcium level rises there may be constipation, abdominal pain, vomiting and dehydration. Very high blood calcium levels can lead to disturbances in the heart rhythm, coma and can rapidly become fatal. A potentially serious complication of hypercalcemia is the inflammation of the pancreas (pancreatitis).

Diagnosis of hypercalcemia is made by measuring calcium level in the blood. The normal range for blood calcium is 2 to 2.5 mmol/litre. Other blood tests like blood phosphorous level, albumin level, alkaline phosphatise and levels of parathyroid hormone are done to ascertain the cause.

Causes and prevention of hypercalcemia

The commonest cause of hypercalcemia is primary hyperparathyroidism in which there is increased secretion of the calcium regulating parathyroid hormone from a tumour of the parathyroid gland. Malignancies are the next common cause of hypercalcemia. Certain drugs like diuretics, vitamin D can also cause hypercalcemia. Other conditions leading to hypercalcemia are tuberculosis, sarcoidosis, hyperthyroidism, endocrine tumour of adrenal gland and AIDS.

Hypercalcemia: Complications

Acute severe hypercalcemia can cause neurological symptoms, cardiac arrhythmias and the patient may lapse into coma. Chronic hypercalcemia can cause calcium deposits in soft tissues, kidney (leading to formation of stones) and cartilage. Also, primary hyperparathyroidism can lead to reduction in mineral density of bones (osteoporosis) which can predispose to fractures with minor trauma.

Hypercalcemia: Treatment

Acute hypercalcemia is treated by administration of intravenous and diuretics (loop diuretics) to help urinary excretion of calcium. Drugs like bisphosphonates (pamidronate, zolidronic acid) and calcitonin are sometimes used to lower blood calcium levels. Corticosteroids are also given in certain conditions. In patients with primary hyperparathyroidism who fail to respond to above measures, surgical removal of the tumour of parathyroid gland is done for treatment.