Hypercalcemia - Symptoms, causes and treatment

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Hypercalcemia - Symptoms, causes and treatment
Hypercalcemia - Symptoms, causes and treatment
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Hypercalcemia is a condition when the level of calcium in the blood is too high. This condition can cause thinning of bones, kidney stones, and disturbances in the work of the heart and brain

The normal level of calcium in the blood is 10.4 mg/dL, with an ionized calcium level of 5.2 mg/dL. Hypercalcemia is a term for calcium levels in the blood that exceed this value.

Hypercalcemia - Alodokter

Increased blood calcium levels are generally caused by an overactive parathyroid gland. This condition can also be caused by excess vitamin D, cancer, and the use of certain medications.

Causes of Hypercalcemia

Hypercalcemia can be triggered by several conditions, namely:

Hyperparathyroidism

Hypercalcemia is most often caused by hyperparathyroidism. Normally, parathyroid hormone is produced when calcium levels in the blood are low. In hyperparathyroidism, the parathyroid glands become overactive, resulting in overproduction of parathyroid hormone. As a result, calcium levels in the body increase rapidly.

drug poisoning

Increased production of parathyroid hormone can be triggered by the use of certain drugs, including:

  • Lithium, to treat bipolar disorder
  • Hydrochlorothiazide, to treat hypertension and edema

In addition to the drugs above, excessive use of drugs containing calcium carbonate, such as antacids, can increase calcium levels in the blood.

Excess vitamin A or D

Excess vitamin A or D can occur due to taking vitamin A or D supplements with doses that are too high. Over time, increasing amounts of vitamins in the body can increase calcium levels in the blood.

Cancer

Hypercalcemia due to cancer is usually experienced by patients who are hospitalized. About 10–30% of cancer patients develop hypercalcemia when:

  • Cancer causes bones to release calcium into the blood
  • Cancer interferes with the kidneys in the process of removing calcium with urine

Several types of cancer that can trigger hypercalcemia are lung cancer, kidney cancer, breast cancer, and blood cancer (multiple myeloma). Cancer that has spread to the bones can also increase the risk of hypercalcemia.

Hypercalcemia Symptoms

Mild hypercalcemia can occur without any symptoms. Symptoms generally only appear if the hypercalcemia experienced is severe enough.

Symptoms that can arise due to hypercalcemia depend on the part of the body affected, including:

  • Kidneys, with symptoms of excessive thirst, frequent urination, or kidney stones
  • Digestive tract, characterized by abdominal pain, nausea, vomiting, and constipation
  • Bone and muscle, characterized by bone pain and muscle weakness
  • Brain, with symptoms of confusion, fatigue, seizures, to decreased consciousness
  • Heart, characterized by palpitations, fainting, and arrhythmia

While the severity of hypercalcemia can be divided based on the level of calcium in the blood, namely:

  • Mild, if the blood calcium level is 10.5–11, 9 mg/dL
  • Medium, if the blood calcium level is 12, 0–13, 9 mg/dL
  • Hypercalcemia crisis, when blood calcium level is 14, 0–16, 0 mg/dL

When to see a doctor

Consult a doctor if you experience symptoms of hypercalcemia as mentioned above. Examination is also recommended for those of you who have a family history of hypercalcemia or hyperparathyroidism.

Hypercalcemia Diagnosis

Because it rarely causes symptoms, hypercalcemia is generally only detected when the sufferer undergoes a blood test. If the blood calcium level increases, the doctor will run further tests to determine the cause.

To start the examination, the doctor will ask questions related to the patient's medical history, including the drugs being used. The doctor will also perform a physical examination, including by checking the condition of the patient's muscles and reflexes.

To confirm the diagnosis, some of the following tests may be performed:

  • Blood test, to check blood calcium levels and parathyroid hormone levels
  • Urine test, to measure calcium, protein and other substances contained in urine, and check kidney function
  • Chest X-ray, to detect lung cancer
  • Mammography, to detect breast cancer
  • CT scan or MRI, to see the condition of body organs in detail
  • Bone densitometry examination, to check bone density and strength
  • Heart record tests, such as EKG, to check the condition of the heart
  • Biopsies, to detect conditions such as lymphoma or leukemia

Hypercalcemia Treatment

Treatment of hypercalcemia will be adjusted according to the severity of the condition and its cause. In mild hyperlaksemia, doctors will generally only monitor the condition of the patient's bones and kidneys periodically.

If the hypercalcemia experienced by the patient is severe enough, treatment can be carried out using the following methods:

Drugs

Some drugs that can be given to treat hypercalcemia, namely:

  • Calcitonin, to control calcium levels in the blood
  • Canacalcet, to help relieve overactive parathyroid glands
  • Bisphosphonates, to quickly lower blood calcium levels
  • Denosumab, to treat hypercalcemia that cannot be treated with bisphosphonates
  • Prednisone, to treat hypercalcemia caused by high levels of vitamin D
  • Infusion of fluids and diuretics, to quickly lower blood calcium levels that are very high

Operating procedure

In certain cases, surgery is necessary to treat an overactive parathyroid gland. The goal is to remove the affected glandular tissue.

Usually, only one of the four parathyroid glands is affected and needs to be removed. This procedure can be done by injecting a radioactive substance, to help detect the problem part of the gland.

Hypercalcemia Complications

Hypercalcemia or high levels of calcium in the blood can cause complications such as:

  • Osteoporosis
  • Kidney stones
  • Kidney failure
  • Disorders of the nervous system
  • Heart rhythm disorders or arrhythmia

Hypercalcemia Prevention

Hypercalcemia can't always be prevented. However, the risk of this condition occurring can be avoided by taking the following measures:

  • Avoid taking vitamin, mineral or herbal supplements without consulting your doctor first.
  • Always take antihypertensive drugs according to the doctor's advice.
  • Consult a doctor if you have a family history of high calcium, kidney stones, or parathyroid disease.

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