Materiały źródłowe

• #1 Hypercalcaemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypercalcaemia

  Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range for total calcium is 2.12.6 mmol/L (8.810.7 mg/dL, 4.35.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. 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. […] Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/L). Severe hypercalcaemia (above 1516 mg/dL or 3.754 mmol/L) is considered a medical emergency: at these levels, coma and cardiac arrest can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor or coma. In the gut this causes constipation. […] A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/L). The main symptoms of a hypercalcaemic crisis are oliguria or anuria, as well as somnolence or coma.

• #1 Clinical manifestations of hypercalcemia – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-of-hypercalcemia

  Clinical manifestations of hypercalcemia can be produced by a variety of disorders, but primary hyperparathyroidism and malignancy account for most cases. It may be associated with a spectrum of clinical manifestations, ranging from few (if any) symptoms if the hypercalcemia is mild and/or chronic to obtundation and coma if it is severe and/or acute. The symptoms and signs associated with hypercalcemia are typically independent of the etiology. […] The symptoms of hypercalcemia depend upon both the degree of hypercalcemia and the rate of rise in the serum calcium concentration. In addition, there is individual variation in the manifestation of symptoms. […] Mild hypercalcemia – Patients with mild hypercalcemia (calcium above the upper limit of normal but <12 mg/dL [3 mmol/L]) may be asymptomatic, or they may report nonspecific symptoms, such as constipation, fatigue, and depression.

• #1 Assessment of hypercalcaemia – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/159

  Calcium is a critical cation involved in cellular transport, membrane function, and bone metabolism. Hypercalcaemia, or calcium in systemic excess, is harmful to the function of excitable membranes leading to skeletal muscle and gastrointestinal smooth muscle fatigue. Effects on cardiac muscle include a shortened QT interval and increased risk of cardiac arrest at very high calcium levels. Neurological sequelae include depression, irritability, and, with high enough levels, coma. Hypercalcaemia quickly exceeds renal capacity for calcium reabsorption, and calcium spills into urine, complexing with phosphate, leading to nephrolithiasis. Precipitation of calcium salts within the kidney can lead to severe renal damage. […] Hypercalcaemia may be mild and occur without symptoms. History may also identify symptoms of high calcium such as renal stones (typical of hyperparathyroidism), lethargy, easy fatigue, confusion, depression, irritability, constipation, and polyuria and polydipsia. Chronic symptoms are more consistent with hyperparathyroidism, whereas more recent onset of symptoms suggests malignancy. […] Elevated calcium may require an intervention to prevent complications such as osteoporosis. Severe hypercalcaemia is a life-threatening electrolyte emergency requiring prompt recognition and urgent treatment.

• #1 Hypercalcemia (High Level of Calcium in the Blood) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypercalcemia-high-level-of-calcium-in-the-blood

  At first, people have digestive problems, feel thirsty, and may urinate a lot, but if severe, hypercalcemia leads to confusion and eventually coma. If not recognized and treated, the disorder can be life threatening. […] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large amounts of urine, resulting in dehydration and increased thirst. […] Long-term or severe hypercalcemia commonly results in kidney stones containing calcium. Less commonly, kidney failure develops, but it usually resolves with treatment. However, if enough calcium accumulates within the kidneys, damage is irreversible. […] Very severe hypercalcemia often causes brain dysfunction with confusion, emotional disturbances, delirium, hallucinations, and coma. Muscle weakness may occur, and abnormal heart rhythms and death can follow.

• #1 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Complications of long-term hypercalcemia are rare since calcium levels are checked in routine blood panels and healthcare providers usually catch hypercalcemia early, but complications can include: Calcium deposits in your kidney (nephrocalcinosis) that cause poor kidney function. Kidney failure. Kidney stones. High blood pressure (hypertension). Depression. Bone cysts. Bone fractures. Osteoporosis.

• #1 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. […] Hypercalcemia leads to hyperpolarization of cell membranes. Patients with levels of calcium between 10.5 and 12 mg per dL can be asymptomatic. When the serum calcium level rises above this stage, multisystem manifestations become apparent. This constellation of symptoms has led to the mnemonic Stones, bones, abdominal moans, and psychic groans, which is used to recall the signs and symptoms of hypercalcemia, particularly as a result of primary hyperparathyroidism. […] Neuromuscular effects include impaired concentration, confusion, corneal calcification, fatigue, and muscle weakness. Nausea, abdominal pain, anorexia, constipation, and, rarely, peptic ulcer disease or pancreatitis are among the gastrointestinal manifestations. The most important renal effects are polydipsia and polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria. Other renal effects include dehydration and nephrocalcinosis. Cardiovascular effects include hypertension, vascular calcification, and a shortened QT interval on the electrocardiogram.

• #1 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #1 Hypercalcemia: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/hypercalcemia

  Hypercalcemia makes it hard for the body to carry out its normal functions. Extremely high levels of calcium can be life-threatening. […] You might not have any noticeable symptoms if you have mild hypercalcemia. If you have a more serious case, you will typically have signs and symptoms that affect various parts of your body. […] Symptoms related to the kidneys include: excessive thirst, excessive urination, pain between your back and upper abdomen on one side due to kidney stones. […] High calcium can affect the electrical system of the heart, causing abnormal heart rhythms. […] Calcium levels can affect your muscles, causing twitches, cramps, and weakness. […] High calcium levels can affect bones, leading to: bone pain, osteoporosis, fractures from disease. […] Hypercalcemia can also cause neurological symptoms, such as depression, memory loss, and irritability. Severe cases can cause confusion and coma.

• #1 Hypercalcemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523

  Hypercalcemia is a condition in which the calcium level in the blood becomes too high. Too much calcium in the blood can weaken bones and create kidney stones. It also can affect the heart and brain. […] Some people have no symptoms of this condition. Others have symptoms that range from mild to serious. Treatment depends on the cause. […] You might not have any symptoms if your hypercalcemia is mild. If it’s more serious, your symptoms are related to the parts of your body affected by high blood calcium levels. Examples include: […] Excess calcium makes the kidneys work harder to filter it. This can cause serious thirst and frequent urination. […] Hypercalcemia can cause stomach upset or pain, vomiting, and constipation. […] Most often, the extra calcium in the blood is leached from the bones. This weakens the bones. It can cause bone pain and muscle weakness.

• #1 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system. […] Cardiac tissue also relies on calcium homeostasis, and hypercalcemia can lead to shortened QT intervals, prolonged PR intervals, and widened QRS complex on electrocardiogram (ECG). Cardiac manifestations include bradycardia, heart block, and other arrhythmias, which can be life-threatening. At severe levels, hypercalcemia can even lead to stupor or coma. Chronically high levels of hypercalcemia can also cause calcium renal stones, pancreatitis, and peptic ulcers. Patients with hypercalcemia due to hyperparathyroidism can present with fractures from osteopenia and osteoporosis. The collective symptoms of hypercalcemia are often summarized by the phrases groans, bones, stones, moans, thrones, and psychiatric overtones.

• #1 Hypercalcemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523

  Hypercalcemia can affect how the brain works. That can lead to trouble focusing, confusion, drowsiness and fatigue. It also can cause depression. […] Rarely, serious hypercalcemia can affect the heart. It can cause feelings of a fast-beating, fluttering or pounding heart. It also can cause the heart to beat out of rhythm. It’s linked with other heart-related conditions as well. […] Call your healthcare professional if you think you have any symptoms of hypercalcemia. These can include extreme thirst, frequent urination and pain in the stomach area.

• #1 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Renal effects include the following: Polyuria, Nephrogenic diabetes insipidus, Nocturia, Dehydration, Renal stones, Distal renal tubular acidosis, Acute kidney injury, Chronic kidney disease. […] Hypercalcemia from malignancy usually is rapidly progressive; thus, rapidly rising calcium levels should increase suspicion of malignancy. Hypercalcemia from hyperparathyroidism is usually mild, asymptomatic, and sustained for years. […] Morbidity and mortality from hypercalcemia depend entirely on the cause. Hypercalcemia from hyperparathyroidism tends to be mild and prolonged. Morbidity is related to the resultant bone disease. Because this condition is underdiagnosed so often, actual morbidity is unknown. Mild hypercalcemia rarely, if ever, leads directly to death. […] Hypercalcemia caused by a neoplasm tends to be much more serious. The mechanism of hypercalcemia in malignancy can be from the ectopic production of a PTH-like factor, PTH-related protein (PTHrP), or osteolytic metastases. Cancers that produce PTHrP include breast cancer, lung cancer, prostate cancer, and multiple myeloma. […] Cancer-related hypercalcemia most often occurs in later-stage malignancies and it predicts a poor prognosis for patients with it.

• #1 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  Whether someone with hypercalcemia will have symptoms is dependent upon the degree of hypercalcemia, the duration of the hypercalcemia and the age of the child. […] Some of the most common symptoms include: Kidney pain (due to kidney stones), Bone pain, Aches and pains, Abdominal pain, Nausea and vomiting, Poor appetite, Constipation, Chronic fatigue/tiredness, Excessive sleepiness, Frequent urination, Increased thirst, Confusion, Muscle weakness. […] When the serum calcium concentration is only slightly elevated, infants and children may not have symptoms or may have nonspecific symptoms, such as mild fatigue or constipation. For more severe cases, children may become very weak and irritable, may have nausea and loss of appetite, and may experience poor weight gain, but each child may experience symptoms differently.

• #1 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  Delirium; can be described as a temporary and reversible brain dysfunction syndrome, which manifests itself primarily with physical, physiopathological and psychological disorders. The leading causes of delirium are pneumonia, cancer, urinary infection, electrolyte imbalance (hypo-hypernatremia, hypo-hypercalcemia, hypo-hypermagnesemia), dehydration, congestive heart failure, uremia and stroke. […] Hyperparathyroidism, malignancy and long-lasting immobilization are the most common causes of hypercalcemia in the elderly. Neuropsychiatric symptoms due to hypercalcemia may occur initially with concentration and increase in sleep time. As the degree of hypercalcemia increases, depression, delirium, confusion and afterwards coma may develop. […] Hypercalcemia is defined as a level of plasma calcium more than 1 mg/dL above the laboratory reference range. According to serum calcium levels, 10.5-12 mg/dL is defined as mild, 12-15 mg/dL as moderate, and 15 mg/dL as severe hypercalcemia (hypercalcemic crisis).

• #1 High calcium levels (hypercalcemia) | Canadian Cancer Society

  https://cancer.ca/en/treatments/side-effects/high-calcium-levels

  Hypercalcemia means there is too much calcium in the blood. It is the most common life-threatening complication of cancer in adults. Hypercalcemia develops in 10% to 20% of adults with cancer, but it rarely develops in children. When it develops in people with cancer, it may be called hypercalcemia of malignancy (HCM). […] Symptoms of hypercalcemia can vary and may get worse as hypercalcemia progresses. […] Symptoms of hypercalcemia include: nausea, vomiting, loss of appetite, constipation, fatigue, muscle weakness, increased thirst, having to pee (urinate) more often, dark yellow pee (urine), little or no sweating, abnormal heartbeat, confusion and difficulty thinking clearly, problems concentrating, lethargy, kidney stones, bone pain or broken bones, coma. […] Report symptoms to your healthcare team as soon as possible.

• #1 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #1 Hypercalcemia of Malignancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6505545/

  Hypercalcemia of malignancy (HCM) is a common concern in patients being treated for cancer, affecting over a quarter of this population. Common signs and symptoms of HCM can range from mild gastrointestinal disturbances and fatigue to seizures, coma, or even cardiac arrest depending on the severity of the laboratory abnormality. Hypercalcemia of malignancy typically occurs more acutely compared to other causes of hypercalcemia, often making the clinical manifestations appear more severe in these cases. Hypercalcemia is often divided into categories of mild, moderate, severe, and life-threatening depending on the degree of serum calcium elevation. Cardiovascular clinical manifestations include shortened ST segments and QT intervals, depressed ST segments, widened T waves, prolonged PR and QRS intervals, arrhythmias, ventricular tachycardias, and cardiac arrest. Hypercalcemia of malignancy can also affect the gastrointestinal system. Common signs and symptoms of mild hypercalcemia are anorexia and constipation. Higher degrees of hypercalcemia may also cause nausea, vomiting, weight loss (if chronic), and even pancreatitis or peptic ulcer disease. Renal manifestations of HCM include nephrogenic diabetes insipidus, which causes polyuria, renal vasoconstriction, and distal renal tubular acidosis, often resulting in acute kidney injury and significant dehydration. Clinical manifestations related to the neurologic and musculoskeletal systems are often much more pronounced at moderate to severe levels of hypercalcemia and include anxiety, depression, cognitive dysfunction, lethargy, weakness, fatigue, hyporeflexia, confusion, stupor, and in the most severe cases, coma. Hypercalcemia of malignancy specifically has been associated with posterior reversible leukoencephalopathy syndrome, which presents with headaches, seizures, and subcortical edema on imaging. Although the systems listed above are the most commonly affected, other reported signs and symptoms of hypercalcemia include pruritus, generalized abdominal pain, and bone pain. It is especially important to recognize this constellation of symptoms in patients not previously diagnosed with a malignancy, as the presentation of hypercalcemia may be an important diagnostic clue to finding an underlying cancer in some patients.

• #1 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  The prognosis of hypercalcemia is largely dependent on its etiology. Many processes causing hypercalcemia are benign and have simple treatment options that lead to a good prognosis, such as medication-induced hypercalcemia and primary hyperparathyroidism. When hypercalcemia is due to malignancy or granulomatous disorders, the prognosis may be very poor. Therefore, this is another reason why not only diagnosing hypercalcemia but also determining its etiology is crucial for its proper management.

• #1 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  The immediate treatment of hypercalcemia will be based on the degree of hypercalcemia and whether or not the child has symptoms. Mild cases of hypercalcemia may not require treatment or may require more fluid intake, restriction of calcium or vitamin D intake, or changes in medications. […] For more severe cases, patients are more likely to have symptoms and may require hospitalization for administration of extra fluids by vein (intravenous) as well as the use of calcium-controlling medications given by mouth, injection or intravenously. You child will have frequent blood samples taken to check the level of calcium. If primary hyperparathyroidism is identified, surgery to remove one or more of the parathyroid glands may be considered.

• #1 Hypercalcemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/diagnosis-treatment/drc-20355528

  Hypercalcemia can cause few or no symptoms. So, you might not know you have it until routine blood tests show a high level of calcium. […] For hypercalcemia that is more serious, your healthcare professional might recommend medicines or treatment of the underlying disease. […] Patients can come into the office feeling a variety of symptoms that are generally nonspecific but rather debilitating for them. In many of these cases, we’re able to treat hyperparathyroidism and watch these symptoms literally go away.

• #1 Hypercalcemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000365.htm

  Hypercalcemia means you have too much calcium in your blood. […] The condition is most often diagnosed at an early stage using routine blood tests. Most people have no symptoms. […] Symptoms due to high calcium level may vary, depending on the cause and how long the problem has been present. They may include: Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation; Increased thirst or more frequent urination, due to changes in the kidneys; Muscle weakness or twitches; Changes in how your brain works, such as feeling tired or fatigued or confused; Bone pain and fragile bones that break more easily. […] How well you do depends on the cause of your high calcium level. The outlook is good for people with mild hyperparathyroidism or hypercalcemia that have a treatable cause. Most of the time, there are no complications. […] People with hypercalcemia due to conditions such as cancer or sarcoidosis may not do well. This is most often because of the disease itself, rather than the high calcium level.

• #1 Hypercalcemia: Symptoms, Causes & Effective Treatments

  https://www.bajajallianz.com/blog/wellness/hypercalcemia-symptoms-diagnosis-and-treatment.html

  The symptoms of hypercalcemia can vary depending on the severity of the condition. In mild cases, there may be no noticeable symptoms, while severe hypercalcemia can result in life-threatening complications. Common symptoms include: […] If you notice any of these symptoms, it is important to consult with a healthcare provider for further evaluation and management. […] Early treatment helps in preventing complications such as kidney damage, bone thinning, and heart problems. If you suspect you have hypercalcemia, it is important to consult a healthcare provider promptly. […] Untreated hypercalcemia can lead to kidney failure, heart arrhythmias, bone loss, and even coma. It is essential to address the condition early to avoid these severe complications.

• #1 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your doctor tells you that you have hypercalcemia, it means you have too much calcium in your blood. […] You may not notice any symptoms if you have a mild case of hypercalcemia. But as your body tries to get rid of the extra calcium, you might pee a lot and get really thirsty. If your calcium levels are very high, you could get nervous system problems, including becoming confused and even passing out. […] If you don’t get it treated, high levels of calcium in your blood can lead to bone loss, kidney stones, kidney failure, and heart problems. […] If hyperparathyroidism is the cause of your high calcium, you may also get: Depression, Memory loss, Heartburn, Sleep trouble, Bone and muscle pain, Fatigue. […] About 10%-30% of people with cancer may get hypercalcemia. […] Hypercalcemia from cancer can be hard to manage.

• #1 High calcium levels and cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/blood-calcium/high-calcium-people-cancer

  The aim of treatment is to lower your calcium level and relieve any symptoms. Your treatment will depend on the amount of calcium in your blood. You may need to spend some time in hospital to get your calcium levels down. […] Treatment relieves some symptoms more quickly than others. For example, sickness, constipation and thirst are much easier to relieve than tiredness and loss of appetite. […] It may not be possible to control high calcium if your cancer is very advanced and you are in the final days or weeks of life. But your doctors will do all they can to help make you as comfortable as possible. […] Once your blood calcium levels go back to normal, your doctor will want to keep a close eye on you. You will have regular blood and urine tests to make sure the treatment is still working. […] It is very important that you see your doctor as soon as possible if you feel the symptoms of high calcium are coming back. Even if something else is causing your symptoms, it is better to see your doctor to find out for sure.

• #2 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Symptoms of hypercalcemia are nonspecific and are related to the severity and rate of change of the serum calcium level. Symptoms are more severe with acute changes than with chronic calcium level elevation. Patients with a chronic calcium level as high as 12 to 14 mg/dL may tolerate those levels well whereas sudden development of hypercalcemia in this range or higher may lead to dramatic changes in a patient’s mental status. […] A normal extracellular calcium concentration is necessary for normal neuromuscular function. Thus, neurologic dysfunction is the major feature of hypercalcemic states. Patients can experience slight difficulties in concentrating to depression, confusion, and coma. These symptoms may resolve or improve after the hypercalcemia is corrected. Muscle weakness may also occur.

• #2 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Hypercalcemia happens when you have higher-than-normal levels of calcium in your blood. Hypercalcemia can be mild or severe and temporary or chronic (lifelong). […] Most cases of hypercalcemia aren’t life-threatening and many people don’t have any symptoms. Healthcare providers often catch it early from routine blood tests. […] More severe and/or long-term cases of hypercalcemia may cause the following symptoms: More frequent urination and thirst. Fatigue. Bone pain. Headaches. Nausea and vomiting. Constipation. Decrease in appetite. Forgetfulness, depression or irritability. Muscle aches, weakness, cramping and/or twitches. […] Prognosis, like treatment, depends on the cause and severity of hypercalcemia. When hypercalcemia happens due to a benign condition or temporary situation, it generally has a good prognosis. People who have hypercalcemia due to cancer often experience symptoms and require frequent hospitalizations.

• #2 Hypercalcaemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypercalcaemia

  Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range for total calcium is 2.12.6 mmol/L (8.810.7 mg/dL, 4.35.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. 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. […] Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/L). Severe hypercalcaemia (above 1516 mg/dL or 3.754 mmol/L) is considered a medical emergency: at these levels, coma and cardiac arrest can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor or coma. In the gut this causes constipation. […] A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/L). The main symptoms of a hypercalcaemic crisis are oliguria or anuria, as well as somnolence or coma.

• #2 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #2 Hypercalcemia (High Level of Calcium in the Blood) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypercalcemia-high-level-of-calcium-in-the-blood

  At first, people have digestive problems, feel thirsty, and may urinate a lot, but if severe, hypercalcemia leads to confusion and eventually coma. If not recognized and treated, the disorder can be life threatening. […] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large amounts of urine, resulting in dehydration and increased thirst. […] Long-term or severe hypercalcemia commonly results in kidney stones containing calcium. Less commonly, kidney failure develops, but it usually resolves with treatment. However, if enough calcium accumulates within the kidneys, damage is irreversible. […] Very severe hypercalcemia often causes brain dysfunction with confusion, emotional disturbances, delirium, hallucinations, and coma. Muscle weakness may occur, and abnormal heart rhythms and death can follow.

• #2 Hypercalcaemia: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hypercalcaemia

  Elevated calcium concentrations have painful side-effects and are associated with significantly reduced quality of life and increased healthcare consumption. […] As effective calcium regulation is required for the healthy working of most cells in the body, a high level can produce a diverse collection of symptoms including: […] If the hypercalcaemia is long-standing, calcium may be deposited in soft tissues or may result in stone formation – eg, nephrocalcinosis, nephrolithiasis or chondrocalcinosis. […] At levels 2.8 mmol/L: Polyuria and polydipsia, Dyspepsia – due to calcium-regulated release of gastrin, Depression, Mild cognitive impairment. […] At levels 3.5 mmol/L: All of the previous plus: Muscle weakness, Constipation, Anorexia and nausea, Fatigue. […] At levels 3.5 mmol/L: All of the previous plus: Abdominal pain, Vomiting, Dehydration, Lethargy, Cardiac arrhythmias, shortened QT interval, Coma, Pancreatitis.

• #2 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. […] Hypercalcemia leads to hyperpolarization of cell membranes. Patients with levels of calcium between 10.5 and 12 mg per dL can be asymptomatic. When the serum calcium level rises above this stage, multisystem manifestations become apparent. This constellation of symptoms has led to the mnemonic Stones, bones, abdominal moans, and psychic groans, which is used to recall the signs and symptoms of hypercalcemia, particularly as a result of primary hyperparathyroidism. […] Neuromuscular effects include impaired concentration, confusion, corneal calcification, fatigue, and muscle weakness. Nausea, abdominal pain, anorexia, constipation, and, rarely, peptic ulcer disease or pancreatitis are among the gastrointestinal manifestations. The most important renal effects are polydipsia and polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria. Other renal effects include dehydration and nephrocalcinosis. Cardiovascular effects include hypertension, vascular calcification, and a shortened QT interval on the electrocardiogram.

• #2 Hypercalcemia – Office Instructions – ENT Specialty Care

  https://www.entspecialtycare.com/provider-physician/instructions-hypercalcemia/

  Hypertension is seen with increased frequency in patients with hypercalcemia and may be caused by renal insufficiency calcium-mediated vasoconstriction or both. […] Constipation anorexia nausea and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue musculoskeletal weakness and pain are the only symptoms known to correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels usually above 15 mg/dL and severe symptoms of hypercalcemia particularly central nervous system dysfunction. Abdominal pain pancreatitis peptic ulcer disease nausea and vomiting are also seen more commonly in these patients.

• #2 Hypercalcemia: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/hypercalcemia

  Hypercalcemia makes it hard for the body to carry out its normal functions. Extremely high levels of calcium can be life-threatening. […] You might not have any noticeable symptoms if you have mild hypercalcemia. If you have a more serious case, you will typically have signs and symptoms that affect various parts of your body. […] Symptoms related to the kidneys include: excessive thirst, excessive urination, pain between your back and upper abdomen on one side due to kidney stones. […] High calcium can affect the electrical system of the heart, causing abnormal heart rhythms. […] Calcium levels can affect your muscles, causing twitches, cramps, and weakness. […] High calcium levels can affect bones, leading to: bone pain, osteoporosis, fractures from disease. […] Hypercalcemia can also cause neurological symptoms, such as depression, memory loss, and irritability. Severe cases can cause confusion and coma.

• #2 Hypercalcemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypercalcemia

  Hypercalcemia is a total serum calcium concentration 10.4 mg/dL ( 2.60 mmol/L) or ionized serum calcium 5.2 mg/dL ( 1.30 mmol/L). Clinical features include polyuria, constipation, muscle weakness, confusion, and coma. […] In mild hypercalcemia, many patients are asymptomatic. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal pain, and ileus. Impairment of the renal concentrating mechanism leads to polyuria, nocturia, and polydipsia. Elevation of serum calcium 12 mg/dL ( 3.00 mmol/L) can cause emotional lability, confusion, delirium, psychosis, stupor, and coma. Hypercalcemia may cause neuromuscular symptoms, including skeletal muscle weakness. Hypercalciuria with nephrolithiasis is common. […] Less often, prolonged or severe hypercalcemia causes reversible acute kidney injury or irreversible kidney damage due to nephrocalcinosis (precipitation of calcium salts within the kidney parenchyma). […] In severe hypercalcemia a shortened QTc interval is shown on ECG, and arrhythmias may occur, particularly in patients taking digoxin. Hypercalcemia 18 mg/dL ( 4.50 mmol/L) may cause shock, renal failure, and death.

• #2 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system. […] Cardiac tissue also relies on calcium homeostasis, and hypercalcemia can lead to shortened QT intervals, prolonged PR intervals, and widened QRS complex on electrocardiogram (ECG). Cardiac manifestations include bradycardia, heart block, and other arrhythmias, which can be life-threatening. At severe levels, hypercalcemia can even lead to stupor or coma. Chronically high levels of hypercalcemia can also cause calcium renal stones, pancreatitis, and peptic ulcers. Patients with hypercalcemia due to hyperparathyroidism can present with fractures from osteopenia and osteoporosis. The collective symptoms of hypercalcemia are often summarized by the phrases groans, bones, stones, moans, thrones, and psychiatric overtones.

• #2 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Renal effects include the following: Polyuria, Nephrogenic diabetes insipidus, Nocturia, Dehydration, Renal stones, Distal renal tubular acidosis, Acute kidney injury, Chronic kidney disease. […] Hypercalcemia from malignancy usually is rapidly progressive; thus, rapidly rising calcium levels should increase suspicion of malignancy. Hypercalcemia from hyperparathyroidism is usually mild, asymptomatic, and sustained for years. […] Morbidity and mortality from hypercalcemia depend entirely on the cause. Hypercalcemia from hyperparathyroidism tends to be mild and prolonged. Morbidity is related to the resultant bone disease. Because this condition is underdiagnosed so often, actual morbidity is unknown. Mild hypercalcemia rarely, if ever, leads directly to death. […] Hypercalcemia caused by a neoplasm tends to be much more serious. The mechanism of hypercalcemia in malignancy can be from the ectopic production of a PTH-like factor, PTH-related protein (PTHrP), or osteolytic metastases. Cancers that produce PTHrP include breast cancer, lung cancer, prostate cancer, and multiple myeloma. […] Cancer-related hypercalcemia most often occurs in later-stage malignancies and it predicts a poor prognosis for patients with it.

• #2 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Hypercalcemia is defined as a condition in which the serum calcium level is 10.5 mg/dL (the upper limit of normal) or the ionized calcium level exceeds 5.6 mg/dL. The consequences of abnormally high serum calcium can range from asymptomatic to life-threatening. In addition, excessively high serum calcium causes clinical manifestations that affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. Malignancy is a common cause of hypercalcemia, particularly when bone metastases exist. Because some tumor cells can resorb or destroy bone tissue, hypercalcemia of malignancy develops more rapidly and more aggressively than hypercalcemia related to other conditions, and includes the classic symptoms of dehydration, anorexia, nausea, vomiting, constipation, confusion, and polyuria. Hypercalcemia is a common complication of various types of cancer, including squamous-cell carcinoma, multiple myeloma, T-cell lymphoma, and breast carcinoma.

• #2 Neonatal Hypercalcemia – Pediatrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pediatrics/metabolic-electrolyte-and-toxic-disorders-in-neonates/neonatal-hypercalcemia

  Hypercalcemia is total serum calcium 12 mg/dL ( 3 mmol/L) or ionized calcium 6 mg/dL ( 1.5 mmol/L). Gastrointestinal signs may occur (eg, anorexia, vomiting, constipation) and sometimes lethargy or seizures. […] Symptoms and signs of neonatal hypercalcemia may be noted when total serum calcium is 12 mg/dL ( 3 mmol/L). These signs can include anorexia, gastroesophageal reflux, nausea, vomiting, lethargy or seizures or generalized irritability, and hypertension. Other symptoms and signs include constipation, abdominal pain, dehydration, feeding intolerance, and failure to thrive. Some neonates have weakness. […] With subcutaneous fat necrosis, firm purple nodules may be observed on the trunk, buttocks, or legs.

• #2 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  Delirium; can be described as a temporary and reversible brain dysfunction syndrome, which manifests itself primarily with physical, physiopathological and psychological disorders. The leading causes of delirium are pneumonia, cancer, urinary infection, electrolyte imbalance (hypo-hypernatremia, hypo-hypercalcemia, hypo-hypermagnesemia), dehydration, congestive heart failure, uremia and stroke. […] Hyperparathyroidism, malignancy and long-lasting immobilization are the most common causes of hypercalcemia in the elderly. Neuropsychiatric symptoms due to hypercalcemia may occur initially with concentration and increase in sleep time. As the degree of hypercalcemia increases, depression, delirium, confusion and afterwards coma may develop. […] Hypercalcemia is defined as a level of plasma calcium more than 1 mg/dL above the laboratory reference range. According to serum calcium levels, 10.5-12 mg/dL is defined as mild, 12-15 mg/dL as moderate, and 15 mg/dL as severe hypercalcemia (hypercalcemic crisis).

• #2 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #2 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  The immediate treatment of hypercalcemia will be based on the degree of hypercalcemia and whether or not the child has symptoms. Mild cases of hypercalcemia may not require treatment or may require more fluid intake, restriction of calcium or vitamin D intake, or changes in medications. […] For more severe cases, patients are more likely to have symptoms and may require hospitalization for administration of extra fluids by vein (intravenous) as well as the use of calcium-controlling medications given by mouth, injection or intravenously. You child will have frequent blood samples taken to check the level of calcium. If primary hyperparathyroidism is identified, surgery to remove one or more of the parathyroid glands may be considered.

• #2 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  The prognosis of hypercalcemia is largely dependent on its etiology. Many processes causing hypercalcemia are benign and have simple treatment options that lead to a good prognosis, such as medication-induced hypercalcemia and primary hyperparathyroidism. When hypercalcemia is due to malignancy or granulomatous disorders, the prognosis may be very poor. Therefore, this is another reason why not only diagnosing hypercalcemia but also determining its etiology is crucial for its proper management.

• #2 Hypercalcemia: Symptoms, Causes & Effective Treatments

  https://www.bajajallianz.com/blog/wellness/hypercalcemia-symptoms-diagnosis-and-treatment.html

  The symptoms of hypercalcemia can vary depending on the severity of the condition. In mild cases, there may be no noticeable symptoms, while severe hypercalcemia can result in life-threatening complications. Common symptoms include: […] If you notice any of these symptoms, it is important to consult with a healthcare provider for further evaluation and management. […] Early treatment helps in preventing complications such as kidney damage, bone thinning, and heart problems. If you suspect you have hypercalcemia, it is important to consult a healthcare provider promptly. […] Untreated hypercalcemia can lead to kidney failure, heart arrhythmias, bone loss, and even coma. It is essential to address the condition early to avoid these severe complications.

• #2 High calcium levels and cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/blood-calcium/high-calcium-people-cancer

  The aim of treatment is to lower your calcium level and relieve any symptoms. Your treatment will depend on the amount of calcium in your blood. You may need to spend some time in hospital to get your calcium levels down. […] Treatment relieves some symptoms more quickly than others. For example, sickness, constipation and thirst are much easier to relieve than tiredness and loss of appetite. […] It may not be possible to control high calcium if your cancer is very advanced and you are in the final days or weeks of life. But your doctors will do all they can to help make you as comfortable as possible. […] Once your blood calcium levels go back to normal, your doctor will want to keep a close eye on you. You will have regular blood and urine tests to make sure the treatment is still working. […] It is very important that you see your doctor as soon as possible if you feel the symptoms of high calcium are coming back. Even if something else is causing your symptoms, it is better to see your doctor to find out for sure.

• #3 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Hypercalcemia can result when too much calcium enters the extracellular fluid or when there is insufficient calcium excretion from the kidneys. Approximately 90% of cases of hypercalcemia are caused by hyperparathyroidism or malignancy. […] The severity of symptoms is related not only to the absolute calcium level but also to how fast the rise in serum calcium occurred. Mild prolonged hypercalcemia may produce mild or no symptoms, or recurring problems such as kidney stones. Sudden-onset and severe hypercalcemia may cause dramatic symptoms, usually including confusion and lethargy, possibly leading quickly to death. Serum calcium levels greater than approximately 15 mg/dL usually are considered to be a medical emergency and must be treated aggressively. […] Hypercalcemia affects nearly every organ system in the body, but it particularly affects the central nervous system (CNS) and the kidneys. CNS effects include the following: Lethargy, Muscle weakness, Bone pain, Confusion, Stupor, Coma.

• #3 Hypercalcemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/diagnosis-treatment/drc-20355528

  Hypercalcemia can cause few or no symptoms. So, you might not know you have it until routine blood tests show a high level of calcium. […] For hypercalcemia that is more serious, your healthcare professional might recommend medicines or treatment of the underlying disease. […] Patients can come into the office feeling a variety of symptoms that are generally nonspecific but rather debilitating for them. In many of these cases, we’re able to treat hyperparathyroidism and watch these symptoms literally go away.

• #3 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  When plasma calcium levels are between 10.5-12.0 mg/dL, more than half of the cases are asymptomatic. When calcium levels exceed 13 mg/dL, symptoms and findings that negatively affect many systems are seen. Neuropsychiatric symptoms such as impaired concentration and increased sleep duration may occur initially due to hypercalcemia. As the calcium level increases, depression, delirium, confusion, and then coma may develop. […] In our patient, we think that delirium development was caused by hypercalcemia and dehydration. Delirium disappeared after hydration and serum calcium levels were restored to within normal limits. Delirium is multifactorial, and causes serious problems for affected patients, family members, caregivers and healthcare providers. The general purpose of delirium treatment is therefore early diagnosis and treatment with a multidisciplinary approach, which are of great importance in appropriate cases with delirium.

• #3 Hypercalcemia of Malignancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6505545/

  Hypercalcemia of malignancy (HCM) is a common concern in patients being treated for cancer, affecting over a quarter of this population. Common signs and symptoms of HCM can range from mild gastrointestinal disturbances and fatigue to seizures, coma, or even cardiac arrest depending on the severity of the laboratory abnormality. Hypercalcemia of malignancy typically occurs more acutely compared to other causes of hypercalcemia, often making the clinical manifestations appear more severe in these cases. Hypercalcemia is often divided into categories of mild, moderate, severe, and life-threatening depending on the degree of serum calcium elevation. Cardiovascular clinical manifestations include shortened ST segments and QT intervals, depressed ST segments, widened T waves, prolonged PR and QRS intervals, arrhythmias, ventricular tachycardias, and cardiac arrest. Hypercalcemia of malignancy can also affect the gastrointestinal system. Common signs and symptoms of mild hypercalcemia are anorexia and constipation. Higher degrees of hypercalcemia may also cause nausea, vomiting, weight loss (if chronic), and even pancreatitis or peptic ulcer disease. Renal manifestations of HCM include nephrogenic diabetes insipidus, which causes polyuria, renal vasoconstriction, and distal renal tubular acidosis, often resulting in acute kidney injury and significant dehydration. Clinical manifestations related to the neurologic and musculoskeletal systems are often much more pronounced at moderate to severe levels of hypercalcemia and include anxiety, depression, cognitive dysfunction, lethargy, weakness, fatigue, hyporeflexia, confusion, stupor, and in the most severe cases, coma. Hypercalcemia of malignancy specifically has been associated with posterior reversible leukoencephalopathy syndrome, which presents with headaches, seizures, and subcortical edema on imaging. Although the systems listed above are the most commonly affected, other reported signs and symptoms of hypercalcemia include pruritus, generalized abdominal pain, and bone pain. It is especially important to recognize this constellation of symptoms in patients not previously diagnosed with a malignancy, as the presentation of hypercalcemia may be an important diagnostic clue to finding an underlying cancer in some patients.

• #3 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Renal effects include the following: Polyuria, Nephrogenic diabetes insipidus, Nocturia, Dehydration, Renal stones, Distal renal tubular acidosis, Acute kidney injury, Chronic kidney disease. […] Hypercalcemia from malignancy usually is rapidly progressive; thus, rapidly rising calcium levels should increase suspicion of malignancy. Hypercalcemia from hyperparathyroidism is usually mild, asymptomatic, and sustained for years. […] Morbidity and mortality from hypercalcemia depend entirely on the cause. Hypercalcemia from hyperparathyroidism tends to be mild and prolonged. Morbidity is related to the resultant bone disease. Because this condition is underdiagnosed so often, actual morbidity is unknown. Mild hypercalcemia rarely, if ever, leads directly to death. […] Hypercalcemia caused by a neoplasm tends to be much more serious. The mechanism of hypercalcemia in malignancy can be from the ectopic production of a PTH-like factor, PTH-related protein (PTHrP), or osteolytic metastases. Cancers that produce PTHrP include breast cancer, lung cancer, prostate cancer, and multiple myeloma. […] Cancer-related hypercalcemia most often occurs in later-stage malignancies and it predicts a poor prognosis for patients with it.

• #3 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #3 Hypercalcemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523

  Hypercalcemia is a condition in which the calcium level in the blood becomes too high. Too much calcium in the blood can weaken bones and create kidney stones. It also can affect the heart and brain. […] Some people have no symptoms of this condition. Others have symptoms that range from mild to serious. Treatment depends on the cause. […] You might not have any symptoms if your hypercalcemia is mild. If it’s more serious, your symptoms are related to the parts of your body affected by high blood calcium levels. Examples include: […] Excess calcium makes the kidneys work harder to filter it. This can cause serious thirst and frequent urination. […] Hypercalcemia can cause stomach upset or pain, vomiting, and constipation. […] Most often, the extra calcium in the blood is leached from the bones. This weakens the bones. It can cause bone pain and muscle weakness.

• #3 Orphanet: Familial hypocalciuric hypercalcemia

  https://www.orpha.net/en/disease/detail/405

  Familial hypocalciuric hypercalcemia (FHH) is a generally asymptomatic genetic disorder of phosphocalcic metabolism characterized by lifelong moderate hypercalcemia along with normo- or hypocalciuria and elevated plasma parathyroid hormone (PTH) concentration. […] FHH is usually asymptomatic but rarely symptoms of fatigue, weakness, excessive thirst and concentration problems are experienced. Some adults suffer from relapsing pancreatitis, chondrocalcinosis and premature vascular calcification. […] FHH does not lower life expectancy and has a benign, stable course.

• #3 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. […] Hypercalcemia leads to hyperpolarization of cell membranes. Patients with levels of calcium between 10.5 and 12 mg per dL can be asymptomatic. When the serum calcium level rises above this stage, multisystem manifestations become apparent. This constellation of symptoms has led to the mnemonic Stones, bones, abdominal moans, and psychic groans, which is used to recall the signs and symptoms of hypercalcemia, particularly as a result of primary hyperparathyroidism. […] Neuromuscular effects include impaired concentration, confusion, corneal calcification, fatigue, and muscle weakness. Nausea, abdominal pain, anorexia, constipation, and, rarely, peptic ulcer disease or pancreatitis are among the gastrointestinal manifestations. The most important renal effects are polydipsia and polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria. Other renal effects include dehydration and nephrocalcinosis. Cardiovascular effects include hypertension, vascular calcification, and a shortened QT interval on the electrocardiogram.

• #3 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system. […] Cardiac tissue also relies on calcium homeostasis, and hypercalcemia can lead to shortened QT intervals, prolonged PR intervals, and widened QRS complex on electrocardiogram (ECG). Cardiac manifestations include bradycardia, heart block, and other arrhythmias, which can be life-threatening. At severe levels, hypercalcemia can even lead to stupor or coma. Chronically high levels of hypercalcemia can also cause calcium renal stones, pancreatitis, and peptic ulcers. Patients with hypercalcemia due to hyperparathyroidism can present with fractures from osteopenia and osteoporosis. The collective symptoms of hypercalcemia are often summarized by the phrases groans, bones, stones, moans, thrones, and psychiatric overtones.

• #3 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  In many patients, primary hyperparathyroidism progresses very slowly. Patients should be considered for parathyroidectomy only if they meet criteria recommended by the National Institutes of Health Consensus Development Conference. The disease will progress in approximately one fourth of patients who do not undergo surgery. […] Hypercalcemia of malignancy occurs in several settings. It is mediated most commonly by systemic PTHrP in patients with solid tumors. This is known as the humoral hypercalcemia of malignancy. PTHrP mimics the bone and renal effects of PTH. In contrast to primary hyperparathyroidism, the humoral hypercalcemia of malignancy is associated with suppressed PTH levels and normal calcitriol levels.

• #3 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  Whether someone with hypercalcemia will have symptoms is dependent upon the degree of hypercalcemia, the duration of the hypercalcemia and the age of the child. […] Some of the most common symptoms include: Kidney pain (due to kidney stones), Bone pain, Aches and pains, Abdominal pain, Nausea and vomiting, Poor appetite, Constipation, Chronic fatigue/tiredness, Excessive sleepiness, Frequent urination, Increased thirst, Confusion, Muscle weakness. […] When the serum calcium concentration is only slightly elevated, infants and children may not have symptoms or may have nonspecific symptoms, such as mild fatigue or constipation. For more severe cases, children may become very weak and irritable, may have nausea and loss of appetite, and may experience poor weight gain, but each child may experience symptoms differently.

• #3 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  Delirium; can be described as a temporary and reversible brain dysfunction syndrome, which manifests itself primarily with physical, physiopathological and psychological disorders. The leading causes of delirium are pneumonia, cancer, urinary infection, electrolyte imbalance (hypo-hypernatremia, hypo-hypercalcemia, hypo-hypermagnesemia), dehydration, congestive heart failure, uremia and stroke. […] Hyperparathyroidism, malignancy and long-lasting immobilization are the most common causes of hypercalcemia in the elderly. Neuropsychiatric symptoms due to hypercalcemia may occur initially with concentration and increase in sleep time. As the degree of hypercalcemia increases, depression, delirium, confusion and afterwards coma may develop. […] Hypercalcemia is defined as a level of plasma calcium more than 1 mg/dL above the laboratory reference range. According to serum calcium levels, 10.5-12 mg/dL is defined as mild, 12-15 mg/dL as moderate, and 15 mg/dL as severe hypercalcemia (hypercalcemic crisis).

• #3 Hypercalcemia in Cancer: Causes, Symptoms, and Management – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/features/hypercalcemia-in-cancer-causes-symptoms-and-management/

  Hypercalcemia affects up to 30% of patients with cancer. Hypercalcemia can be classified as mild (10.5-11.9 mg/dL), moderate (12.0-13.9 mg/dL), or hypercalcemic crisis (14.0-16.0 mg/dL). Patients with hypercalcemia may present with kidney stones; chronic renal insufficiency; bone pain; excessive urine production; gastrointestinal symptoms such as nausea, vomiting, and constipation; pancreatitis; peptic ulcers; and neuropsychiatric symptoms such as anxiety, depression, lethargy, and confusion. […] Hypercalcemia is the first presenting sign of cancer in some cases of hematologic malignancy, but it often goes unrecognized by non-oncologists. Patients may have very vague symptoms and think they are just tired and dehydrated. […] For patients in remission, if calcium levels are higher than expected, this might be a sign of the cancer coming back, especially if patients are also complaining of weakness and confusion. […] Given the low survival rates associated with cancer-related hypercalcemia, providers may need to consider engaging palliative care services in some cases.

• #3 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #3 Patient Care Spotlight: Current Management of Hypercalcemia Associated With Multiple Myeloma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/for-physicians/clinical-resources/hematologic-malignancies/advances-newsletter/2013-issue-2/patient-care-spotlight-hypercalcemia-multiple-myeloma

  Patients with multiple myeloma are commonly diagnosed with hypercalcemia. In fact, hypercalcemia is one of the four diagnostic „CRAB” criteria (calcium elevation, renal insufficiency, anemia, or bone disease) used to distinguish smoldering myeloma and monoclonal gammopathies of undetermined significance from active, symptomatic multiple myeloma. About 10 to 15 percent of patients with multiple myeloma present with hypercalcemia at the time of initial diagnosis, while more than 25 percent will be found to have hypercalcemia at some point during the trajectory of their disease, usually at the time of disease progression and relapse. […] Symptoms associated with hypercalcemia may be subtle or dramatic, and can include: nausea and vomiting; confusion or depression; myalgias and arthralgias; dry mouth; polydipsia; anorexia; constipation; abdominal pain; and, eventually, coma. In patients with myeloma, a hypercalcemia diagnosis is often indicative of uncontrolled disease. […] Hypercalcemia is usually an ominous indication that either the myeloma disease has relapsed or that the patient is not responding to current therapy. It is, therefore, important to give systemic myeloma therapy as soon as possible to prevent recurrence of hypercalcemia.

• #3 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  The prognosis of hypercalcemia is largely dependent on its etiology. Many processes causing hypercalcemia are benign and have simple treatment options that lead to a good prognosis, such as medication-induced hypercalcemia and primary hyperparathyroidism. When hypercalcemia is due to malignancy or granulomatous disorders, the prognosis may be very poor. Therefore, this is another reason why not only diagnosing hypercalcemia but also determining its etiology is crucial for its proper management.

• #3 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  The immediate treatment of hypercalcemia will be based on the degree of hypercalcemia and whether or not the child has symptoms. Mild cases of hypercalcemia may not require treatment or may require more fluid intake, restriction of calcium or vitamin D intake, or changes in medications. […] For more severe cases, patients are more likely to have symptoms and may require hospitalization for administration of extra fluids by vein (intravenous) as well as the use of calcium-controlling medications given by mouth, injection or intravenously. You child will have frequent blood samples taken to check the level of calcium. If primary hyperparathyroidism is identified, surgery to remove one or more of the parathyroid glands may be considered.

• #3 Hypercalcemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000365.htm

  Hypercalcemia means you have too much calcium in your blood. […] The condition is most often diagnosed at an early stage using routine blood tests. Most people have no symptoms. […] Symptoms due to high calcium level may vary, depending on the cause and how long the problem has been present. They may include: Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation; Increased thirst or more frequent urination, due to changes in the kidneys; Muscle weakness or twitches; Changes in how your brain works, such as feeling tired or fatigued or confused; Bone pain and fragile bones that break more easily. […] How well you do depends on the cause of your high calcium level. The outlook is good for people with mild hyperparathyroidism or hypercalcemia that have a treatable cause. Most of the time, there are no complications. […] People with hypercalcemia due to conditions such as cancer or sarcoidosis may not do well. This is most often because of the disease itself, rather than the high calcium level.

• #3 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Hypercalcemia happens when you have higher-than-normal levels of calcium in your blood. Hypercalcemia can be mild or severe and temporary or chronic (lifelong). […] Most cases of hypercalcemia aren’t life-threatening and many people don’t have any symptoms. Healthcare providers often catch it early from routine blood tests. […] More severe and/or long-term cases of hypercalcemia may cause the following symptoms: More frequent urination and thirst. Fatigue. Bone pain. Headaches. Nausea and vomiting. Constipation. Decrease in appetite. Forgetfulness, depression or irritability. Muscle aches, weakness, cramping and/or twitches. […] Prognosis, like treatment, depends on the cause and severity of hypercalcemia. When hypercalcemia happens due to a benign condition or temporary situation, it generally has a good prognosis. People who have hypercalcemia due to cancer often experience symptoms and require frequent hospitalizations.

• #3 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your doctor tells you that you have hypercalcemia, it means you have too much calcium in your blood. […] You may not notice any symptoms if you have a mild case of hypercalcemia. But as your body tries to get rid of the extra calcium, you might pee a lot and get really thirsty. If your calcium levels are very high, you could get nervous system problems, including becoming confused and even passing out. […] If you don’t get it treated, high levels of calcium in your blood can lead to bone loss, kidney stones, kidney failure, and heart problems. […] If hyperparathyroidism is the cause of your high calcium, you may also get: Depression, Memory loss, Heartburn, Sleep trouble, Bone and muscle pain, Fatigue. […] About 10%-30% of people with cancer may get hypercalcemia. […] Hypercalcemia from cancer can be hard to manage.

• #3 High calcium levels and cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/blood-calcium/high-calcium-people-cancer

  The aim of treatment is to lower your calcium level and relieve any symptoms. Your treatment will depend on the amount of calcium in your blood. You may need to spend some time in hospital to get your calcium levels down. […] Treatment relieves some symptoms more quickly than others. For example, sickness, constipation and thirst are much easier to relieve than tiredness and loss of appetite. […] It may not be possible to control high calcium if your cancer is very advanced and you are in the final days or weeks of life. But your doctors will do all they can to help make you as comfortable as possible. […] Once your blood calcium levels go back to normal, your doctor will want to keep a close eye on you. You will have regular blood and urine tests to make sure the treatment is still working. […] It is very important that you see your doctor as soon as possible if you feel the symptoms of high calcium are coming back. Even if something else is causing your symptoms, it is better to see your doctor to find out for sure.

• #4 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  Whether someone with hypercalcemia will have symptoms is dependent upon the degree of hypercalcemia, the duration of the hypercalcemia and the age of the child. […] Some of the most common symptoms include: Kidney pain (due to kidney stones), Bone pain, Aches and pains, Abdominal pain, Nausea and vomiting, Poor appetite, Constipation, Chronic fatigue/tiredness, Excessive sleepiness, Frequent urination, Increased thirst, Confusion, Muscle weakness. […] When the serum calcium concentration is only slightly elevated, infants and children may not have symptoms or may have nonspecific symptoms, such as mild fatigue or constipation. For more severe cases, children may become very weak and irritable, may have nausea and loss of appetite, and may experience poor weight gain, but each child may experience symptoms differently.

• #4 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. […] Hypercalcemia leads to hyperpolarization of cell membranes. Patients with levels of calcium between 10.5 and 12 mg per dL can be asymptomatic. When the serum calcium level rises above this stage, multisystem manifestations become apparent. This constellation of symptoms has led to the mnemonic Stones, bones, abdominal moans, and psychic groans, which is used to recall the signs and symptoms of hypercalcemia, particularly as a result of primary hyperparathyroidism. […] Neuromuscular effects include impaired concentration, confusion, corneal calcification, fatigue, and muscle weakness. Nausea, abdominal pain, anorexia, constipation, and, rarely, peptic ulcer disease or pancreatitis are among the gastrointestinal manifestations. The most important renal effects are polydipsia and polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria. Other renal effects include dehydration and nephrocalcinosis. Cardiovascular effects include hypertension, vascular calcification, and a shortened QT interval on the electrocardiogram.

• #4 Hypercalcemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523

  Hypercalcemia is a condition in which the calcium level in the blood becomes too high. Too much calcium in the blood can weaken bones and create kidney stones. It also can affect the heart and brain. […] Some people have no symptoms of this condition. Others have symptoms that range from mild to serious. Treatment depends on the cause. […] You might not have any symptoms if your hypercalcemia is mild. If it’s more serious, your symptoms are related to the parts of your body affected by high blood calcium levels. Examples include: […] Excess calcium makes the kidneys work harder to filter it. This can cause serious thirst and frequent urination. […] Hypercalcemia can cause stomach upset or pain, vomiting, and constipation. […] Most often, the extra calcium in the blood is leached from the bones. This weakens the bones. It can cause bone pain and muscle weakness.

• #4 Hypercalcemia (High Level of Calcium in the Blood) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypercalcemia-high-level-of-calcium-in-the-blood

  At first, people have digestive problems, feel thirsty, and may urinate a lot, but if severe, hypercalcemia leads to confusion and eventually coma. If not recognized and treated, the disorder can be life threatening. […] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large amounts of urine, resulting in dehydration and increased thirst. […] Long-term or severe hypercalcemia commonly results in kidney stones containing calcium. Less commonly, kidney failure develops, but it usually resolves with treatment. However, if enough calcium accumulates within the kidneys, damage is irreversible. […] Very severe hypercalcemia often causes brain dysfunction with confusion, emotional disturbances, delirium, hallucinations, and coma. Muscle weakness may occur, and abnormal heart rhythms and death can follow.

• #4 Symptoms and Signs of Hypercalcemia (Elevated Calcium Levels): Treatment

  https://www.emedicinehealth.com/hypercalcemia_elevated_calcium_levels/symptom.htm

  Hypercalcemia is a condition in which levels of calcium in the body are elevated above what is considered normal (normal calcium vary with age; most labs consider 10.5 mg/dL and above as hypercalcemia in adults over age 35). […] Signs and symptoms of hypercalcemia are minor in most patients but as calcium levels increase, symptoms become more pronounced. Symptoms of hypercalcemia (elevated calcium levels) are often described as „moans, stones, groans, and bones.” […] Moans symptoms of hypercalcemia refer to gastrointestinal conditions including abdominal pain, constipation, decreased appetite, nausea, peptic ulcer disease, and vomiting. […] Stones symptoms of hypercalcemia refer to kidney-related conditions and include flank pain, frequent urination, and kidney stones. […] Groans symptoms of hypercalcemia refer to psychological conditions and include confusion, dementia, depression, and memory loss. […] Bones symptoms of hypercalcemia refer to bone pain and bone-related conditions including bone aches and pains, curving of the spine and loss of height, and fractures. […] Extreme elevations in calcium levels may cause coma.

• #4 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Patients with mild hypercalcemia, defined as total serum calcium of 10.5 mg/dL to 12 mg/dL or ionized calcium of 5.6 mg/dL to 8 mg/dL, can be asymptomatic. The presenting signs and symptoms of hypercalcemia generally occur when the calcium levels exceed those ranges. Patients whose total serum calcium level is consistently between 12 mg/dL and 14 mg/dL may tolerate this level well, but the sudden development of hypercalcemia in this range or above may lead to dramatic changes in the patient’s mental status. The mnemonic „stones, bones, abdominal moans, and psychic groans” represents the constellation of symptoms and signs of hypercalcemia. The clinical manifestations of hypercalcemia can involve many body systems. Central nervous system effects include lethargy, impaired concentration, fatigue, and muscle weakness. Renal effects include dehydration, polyuria, nephrolithiasis resulting from hypercalciuria, nephrogenic diabetic insipidus, and nephrocalcinosis. Gastrointestinal symptoms include nausea, vomiting, anorexia, weight loss, constipation, abdominal pain, pancreatitis, and peptic ulcer disease. Cardiovascular effects include hypertension, shortened QT interval, cardiac arrhythmia, and vascular calcification. Other symptoms include bone pain, arthritis, and osteoporosis. […] Hypercalcemia is a common complication of cancer. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #4 Hypercalcemia: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/hypercalcemia

  Hypercalcemia makes it hard for the body to carry out its normal functions. Extremely high levels of calcium can be life-threatening. […] You might not have any noticeable symptoms if you have mild hypercalcemia. If you have a more serious case, you will typically have signs and symptoms that affect various parts of your body. […] Symptoms related to the kidneys include: excessive thirst, excessive urination, pain between your back and upper abdomen on one side due to kidney stones. […] High calcium can affect the electrical system of the heart, causing abnormal heart rhythms. […] Calcium levels can affect your muscles, causing twitches, cramps, and weakness. […] High calcium levels can affect bones, leading to: bone pain, osteoporosis, fractures from disease. […] Hypercalcemia can also cause neurological symptoms, such as depression, memory loss, and irritability. Severe cases can cause confusion and coma.

• #4 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Complications of long-term hypercalcemia are rare since calcium levels are checked in routine blood panels and healthcare providers usually catch hypercalcemia early, but complications can include: Calcium deposits in your kidney (nephrocalcinosis) that cause poor kidney function. Kidney failure. Kidney stones. High blood pressure (hypertension). Depression. Bone cysts. Bone fractures. Osteoporosis.

• #4 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system. […] Cardiac tissue also relies on calcium homeostasis, and hypercalcemia can lead to shortened QT intervals, prolonged PR intervals, and widened QRS complex on electrocardiogram (ECG). Cardiac manifestations include bradycardia, heart block, and other arrhythmias, which can be life-threatening. At severe levels, hypercalcemia can even lead to stupor or coma. Chronically high levels of hypercalcemia can also cause calcium renal stones, pancreatitis, and peptic ulcers. Patients with hypercalcemia due to hyperparathyroidism can present with fractures from osteopenia and osteoporosis. The collective symptoms of hypercalcemia are often summarized by the phrases groans, bones, stones, moans, thrones, and psychiatric overtones.

• #4 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  In many patients, primary hyperparathyroidism progresses very slowly. Patients should be considered for parathyroidectomy only if they meet criteria recommended by the National Institutes of Health Consensus Development Conference. The disease will progress in approximately one fourth of patients who do not undergo surgery. […] Hypercalcemia of malignancy occurs in several settings. It is mediated most commonly by systemic PTHrP in patients with solid tumors. This is known as the humoral hypercalcemia of malignancy. PTHrP mimics the bone and renal effects of PTH. In contrast to primary hyperparathyroidism, the humoral hypercalcemia of malignancy is associated with suppressed PTH levels and normal calcitriol levels.

• #4 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #4 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #4 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  Delirium; can be described as a temporary and reversible brain dysfunction syndrome, which manifests itself primarily with physical, physiopathological and psychological disorders. The leading causes of delirium are pneumonia, cancer, urinary infection, electrolyte imbalance (hypo-hypernatremia, hypo-hypercalcemia, hypo-hypermagnesemia), dehydration, congestive heart failure, uremia and stroke. […] Hyperparathyroidism, malignancy and long-lasting immobilization are the most common causes of hypercalcemia in the elderly. Neuropsychiatric symptoms due to hypercalcemia may occur initially with concentration and increase in sleep time. As the degree of hypercalcemia increases, depression, delirium, confusion and afterwards coma may develop. […] Hypercalcemia is defined as a level of plasma calcium more than 1 mg/dL above the laboratory reference range. According to serum calcium levels, 10.5-12 mg/dL is defined as mild, 12-15 mg/dL as moderate, and 15 mg/dL as severe hypercalcemia (hypercalcemic crisis).

• #4 Patient Care Spotlight: Current Management of Hypercalcemia Associated With Multiple Myeloma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/for-physicians/clinical-resources/hematologic-malignancies/advances-newsletter/2013-issue-2/patient-care-spotlight-hypercalcemia-multiple-myeloma

  Patients with multiple myeloma are commonly diagnosed with hypercalcemia. In fact, hypercalcemia is one of the four diagnostic „CRAB” criteria (calcium elevation, renal insufficiency, anemia, or bone disease) used to distinguish smoldering myeloma and monoclonal gammopathies of undetermined significance from active, symptomatic multiple myeloma. About 10 to 15 percent of patients with multiple myeloma present with hypercalcemia at the time of initial diagnosis, while more than 25 percent will be found to have hypercalcemia at some point during the trajectory of their disease, usually at the time of disease progression and relapse. […] Symptoms associated with hypercalcemia may be subtle or dramatic, and can include: nausea and vomiting; confusion or depression; myalgias and arthralgias; dry mouth; polydipsia; anorexia; constipation; abdominal pain; and, eventually, coma. In patients with myeloma, a hypercalcemia diagnosis is often indicative of uncontrolled disease. […] Hypercalcemia is usually an ominous indication that either the myeloma disease has relapsed or that the patient is not responding to current therapy. It is, therefore, important to give systemic myeloma therapy as soon as possible to prevent recurrence of hypercalcemia.

• #4 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your calcium levels are very high, for any reason, you’ll need to go to the hospital to get fluids and medicine called diuretics through your veins. This can treat hypercalcemia quickly. […] Severe hypercalcemia is especially hard on your kidneys and heart. It can cause kidney failure and problems with your heart rhythms.

• #4 Hypercalcemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000365.htm

  Hypercalcemia means you have too much calcium in your blood. […] The condition is most often diagnosed at an early stage using routine blood tests. Most people have no symptoms. […] Symptoms due to high calcium level may vary, depending on the cause and how long the problem has been present. They may include: Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation; Increased thirst or more frequent urination, due to changes in the kidneys; Muscle weakness or twitches; Changes in how your brain works, such as feeling tired or fatigued or confused; Bone pain and fragile bones that break more easily. […] How well you do depends on the cause of your high calcium level. The outlook is good for people with mild hyperparathyroidism or hypercalcemia that have a treatable cause. Most of the time, there are no complications. […] People with hypercalcemia due to conditions such as cancer or sarcoidosis may not do well. This is most often because of the disease itself, rather than the high calcium level.

• #4 Diagnosing a disorder with few symptoms | I.M. Matters from ACP

  https://immattersacp.org/archives/2012/03/hypercalcemia.htm

  Hypercalcemia is much more common in patients with cancer than in the general population. […] Myeloma can initially present with hypercalcemia, and the patient may also have some back pain. […] With more advanced hypercalcemia, the patient may present with some delirium, confusion, and deteriorating kidney function due to dehydration. […] Untreated, severe hypercalcemia will lead to coma and death. […] In-hospital management of this type of hypercalcemia includes replacement of fluids and bisphosphonates. […] Dr. LeGrand also advised that a primary care physician should do additional testing to identify the cause of the condition if a patient presents with hypercalcemia and a low PTH.

• #4 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your doctor tells you that you have hypercalcemia, it means you have too much calcium in your blood. […] You may not notice any symptoms if you have a mild case of hypercalcemia. But as your body tries to get rid of the extra calcium, you might pee a lot and get really thirsty. If your calcium levels are very high, you could get nervous system problems, including becoming confused and even passing out. […] If you don’t get it treated, high levels of calcium in your blood can lead to bone loss, kidney stones, kidney failure, and heart problems. […] If hyperparathyroidism is the cause of your high calcium, you may also get: Depression, Memory loss, Heartburn, Sleep trouble, Bone and muscle pain, Fatigue. […] About 10%-30% of people with cancer may get hypercalcemia. […] Hypercalcemia from cancer can be hard to manage.

• #4 High calcium levels and cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/blood-calcium/high-calcium-people-cancer

  The aim of treatment is to lower your calcium level and relieve any symptoms. Your treatment will depend on the amount of calcium in your blood. You may need to spend some time in hospital to get your calcium levels down. […] Treatment relieves some symptoms more quickly than others. For example, sickness, constipation and thirst are much easier to relieve than tiredness and loss of appetite. […] It may not be possible to control high calcium if your cancer is very advanced and you are in the final days or weeks of life. But your doctors will do all they can to help make you as comfortable as possible. […] Once your blood calcium levels go back to normal, your doctor will want to keep a close eye on you. You will have regular blood and urine tests to make sure the treatment is still working. […] It is very important that you see your doctor as soon as possible if you feel the symptoms of high calcium are coming back. Even if something else is causing your symptoms, it is better to see your doctor to find out for sure.

• #5 Clinical manifestations of hypercalcemia – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-of-hypercalcemia

  Moderate hypercalcemia – A moderately elevated serum calcium of 12 to 14 mg/dL (3 to 3.5 mmol/L) may be well tolerated chronically, while an acute rise to these concentrations may cause marked symptoms, including polyuria, polydipsia, dehydration, anorexia, nausea, muscle weakness, and changes in sensorium.

• #5 Hypercalcemia: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/hypercalcemia

  Hypercalcemia makes it hard for the body to carry out its normal functions. Extremely high levels of calcium can be life-threatening. […] You might not have any noticeable symptoms if you have mild hypercalcemia. If you have a more serious case, you will typically have signs and symptoms that affect various parts of your body. […] Symptoms related to the kidneys include: excessive thirst, excessive urination, pain between your back and upper abdomen on one side due to kidney stones. […] High calcium can affect the electrical system of the heart, causing abnormal heart rhythms. […] Calcium levels can affect your muscles, causing twitches, cramps, and weakness. […] High calcium levels can affect bones, leading to: bone pain, osteoporosis, fractures from disease. […] Hypercalcemia can also cause neurological symptoms, such as depression, memory loss, and irritability. Severe cases can cause confusion and coma.

• #5 Hypercalcemia Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/240681-clinical

  The mnemonic „stones, bones, abdominal moans, and psychic groans” describes the constellation of symptoms and signs of hypercalcemia. These may be due directly to the hypercalcemia, to increased calcium and phosphate excretion, or to skeletal changes. […] The presentation in a patient with hypercalcemia varies with how fast and how far the calcium level rises, as well as the sensitivity of the individual to elevated calcium levels. Mild prolonged hypercalcemia may produce mild or no symptoms, or recurring problems such as kidney stones. Sudden-onset and severe hypercalcemia may cause dramatic symptoms, usually including confusion and lethargy, possibly leading quickly to death. […] Central nervous system effects include the following: Lethargy, Weakness, Confusion, Coma. […] Renal effects include the following: Polyuria, Nocturia, Dehydration, Renal stones, Renal failure. […] Gastrointestinal effects include the following: Constipation, Nausea, Anorexia, Pancreatitis, Gastric ulcer. […] Cardiac effects include syncope from arrhythmias.

• #5 Hypercalcemia (High Level of Calcium in the Blood) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypercalcemia-high-level-of-calcium-in-the-blood

  At first, people have digestive problems, feel thirsty, and may urinate a lot, but if severe, hypercalcemia leads to confusion and eventually coma. If not recognized and treated, the disorder can be life threatening. […] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large amounts of urine, resulting in dehydration and increased thirst. […] Long-term or severe hypercalcemia commonly results in kidney stones containing calcium. Less commonly, kidney failure develops, but it usually resolves with treatment. However, if enough calcium accumulates within the kidneys, damage is irreversible. […] Very severe hypercalcemia often causes brain dysfunction with confusion, emotional disturbances, delirium, hallucinations, and coma. Muscle weakness may occur, and abnormal heart rhythms and death can follow.

• #5 Hypercalcemia – EMCrit Project

  https://emcrit.org/ibcc/hypercalcemia/

  symptoms of hypercalcemia: Neurologic: Delirium, which may progress to stupor and coma. […] symptoms of hypercalcemia: Paresthesia. […] symptoms of hypercalcemia: Muscle weakness, hyporeflexia. […] symptoms of hypercalcemia: Abdominal pain, pancreatitis. […] symptoms of hypercalcemia: Constipation, ileus, nausea/vomiting. […] symptoms of hypercalcemia: Diabetes insipidus (with polyuria and polydipsia). […] symptoms of hypercalcemia: Hypertension (if the patient isn’t hypovolemic). […] Overall, ~90% of hypercalcemia is due to hyperparathyroidism or malignancy. Among critically ill patients (especially those with severe hypercalcemia), malignancy is the most likely cause.

• #5 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Hypercalcemia happens when you have higher-than-normal levels of calcium in your blood. Hypercalcemia can be mild or severe and temporary or chronic (lifelong). […] Most cases of hypercalcemia aren’t life-threatening and many people don’t have any symptoms. Healthcare providers often catch it early from routine blood tests. […] More severe and/or long-term cases of hypercalcemia may cause the following symptoms: More frequent urination and thirst. Fatigue. Bone pain. Headaches. Nausea and vomiting. Constipation. Decrease in appetite. Forgetfulness, depression or irritability. Muscle aches, weakness, cramping and/or twitches. […] Prognosis, like treatment, depends on the cause and severity of hypercalcemia. When hypercalcemia happens due to a benign condition or temporary situation, it generally has a good prognosis. People who have hypercalcemia due to cancer often experience symptoms and require frequent hospitalizations.

• #5 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system. […] Cardiac tissue also relies on calcium homeostasis, and hypercalcemia can lead to shortened QT intervals, prolonged PR intervals, and widened QRS complex on electrocardiogram (ECG). Cardiac manifestations include bradycardia, heart block, and other arrhythmias, which can be life-threatening. At severe levels, hypercalcemia can even lead to stupor or coma. Chronically high levels of hypercalcemia can also cause calcium renal stones, pancreatitis, and peptic ulcers. Patients with hypercalcemia due to hyperparathyroidism can present with fractures from osteopenia and osteoporosis. The collective symptoms of hypercalcemia are often summarized by the phrases groans, bones, stones, moans, thrones, and psychiatric overtones.

• #5 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Hypercalcemia can result when too much calcium enters the extracellular fluid or when there is insufficient calcium excretion from the kidneys. Approximately 90% of cases of hypercalcemia are caused by hyperparathyroidism or malignancy. […] The severity of symptoms is related not only to the absolute calcium level but also to how fast the rise in serum calcium occurred. Mild prolonged hypercalcemia may produce mild or no symptoms, or recurring problems such as kidney stones. Sudden-onset and severe hypercalcemia may cause dramatic symptoms, usually including confusion and lethargy, possibly leading quickly to death. Serum calcium levels greater than approximately 15 mg/dL usually are considered to be a medical emergency and must be treated aggressively. […] Hypercalcemia affects nearly every organ system in the body, but it particularly affects the central nervous system (CNS) and the kidneys. CNS effects include the following: Lethargy, Muscle weakness, Bone pain, Confusion, Stupor, Coma.

• #5 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Renal effects include the following: Polyuria, Nephrogenic diabetes insipidus, Nocturia, Dehydration, Renal stones, Distal renal tubular acidosis, Acute kidney injury, Chronic kidney disease. […] Hypercalcemia from malignancy usually is rapidly progressive; thus, rapidly rising calcium levels should increase suspicion of malignancy. Hypercalcemia from hyperparathyroidism is usually mild, asymptomatic, and sustained for years. […] Morbidity and mortality from hypercalcemia depend entirely on the cause. Hypercalcemia from hyperparathyroidism tends to be mild and prolonged. Morbidity is related to the resultant bone disease. Because this condition is underdiagnosed so often, actual morbidity is unknown. Mild hypercalcemia rarely, if ever, leads directly to death. […] Hypercalcemia caused by a neoplasm tends to be much more serious. The mechanism of hypercalcemia in malignancy can be from the ectopic production of a PTH-like factor, PTH-related protein (PTHrP), or osteolytic metastases. Cancers that produce PTHrP include breast cancer, lung cancer, prostate cancer, and multiple myeloma. […] Cancer-related hypercalcemia most often occurs in later-stage malignancies and it predicts a poor prognosis for patients with it.

• #5 Hypercalcaemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypercalcaemia

  Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range for total calcium is 2.12.6 mmol/L (8.810.7 mg/dL, 4.35.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. 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. […] Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/L). Severe hypercalcaemia (above 1516 mg/dL or 3.754 mmol/L) is considered a medical emergency: at these levels, coma and cardiac arrest can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor or coma. In the gut this causes constipation. […] A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/L). The main symptoms of a hypercalcaemic crisis are oliguria or anuria, as well as somnolence or coma.

• #5 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  Whether someone with hypercalcemia will have symptoms is dependent upon the degree of hypercalcemia, the duration of the hypercalcemia and the age of the child. […] Some of the most common symptoms include: Kidney pain (due to kidney stones), Bone pain, Aches and pains, Abdominal pain, Nausea and vomiting, Poor appetite, Constipation, Chronic fatigue/tiredness, Excessive sleepiness, Frequent urination, Increased thirst, Confusion, Muscle weakness. […] When the serum calcium concentration is only slightly elevated, infants and children may not have symptoms or may have nonspecific symptoms, such as mild fatigue or constipation. For more severe cases, children may become very weak and irritable, may have nausea and loss of appetite, and may experience poor weight gain, but each child may experience symptoms differently.

• #5 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  When plasma calcium levels are between 10.5-12.0 mg/dL, more than half of the cases are asymptomatic. When calcium levels exceed 13 mg/dL, symptoms and findings that negatively affect many systems are seen. Neuropsychiatric symptoms such as impaired concentration and increased sleep duration may occur initially due to hypercalcemia. As the calcium level increases, depression, delirium, confusion, and then coma may develop. […] In our patient, we think that delirium development was caused by hypercalcemia and dehydration. Delirium disappeared after hydration and serum calcium levels were restored to within normal limits. Delirium is multifactorial, and causes serious problems for affected patients, family members, caregivers and healthcare providers. The general purpose of delirium treatment is therefore early diagnosis and treatment with a multidisciplinary approach, which are of great importance in appropriate cases with delirium.

• #5 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #5 Hypercalcemia in Cancer: Causes, Symptoms, and Management – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/features/hypercalcemia-in-cancer-causes-symptoms-and-management/

  Hypercalcemia affects up to 30% of patients with cancer. Hypercalcemia can be classified as mild (10.5-11.9 mg/dL), moderate (12.0-13.9 mg/dL), or hypercalcemic crisis (14.0-16.0 mg/dL). Patients with hypercalcemia may present with kidney stones; chronic renal insufficiency; bone pain; excessive urine production; gastrointestinal symptoms such as nausea, vomiting, and constipation; pancreatitis; peptic ulcers; and neuropsychiatric symptoms such as anxiety, depression, lethargy, and confusion. […] Hypercalcemia is the first presenting sign of cancer in some cases of hematologic malignancy, but it often goes unrecognized by non-oncologists. Patients may have very vague symptoms and think they are just tired and dehydrated. […] For patients in remission, if calcium levels are higher than expected, this might be a sign of the cancer coming back, especially if patients are also complaining of weakness and confusion. […] Given the low survival rates associated with cancer-related hypercalcemia, providers may need to consider engaging palliative care services in some cases.

• #5 Hypercalcemia | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypercalcemia

  The immediate treatment of hypercalcemia will be based on the degree of hypercalcemia and whether or not the child has symptoms. Mild cases of hypercalcemia may not require treatment or may require more fluid intake, restriction of calcium or vitamin D intake, or changes in medications. […] For more severe cases, patients are more likely to have symptoms and may require hospitalization for administration of extra fluids by vein (intravenous) as well as the use of calcium-controlling medications given by mouth, injection or intravenously. You child will have frequent blood samples taken to check the level of calcium. If primary hyperparathyroidism is identified, surgery to remove one or more of the parathyroid glands may be considered.

• #5 Hypercalcemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000365.htm

  Hypercalcemia means you have too much calcium in your blood. […] The condition is most often diagnosed at an early stage using routine blood tests. Most people have no symptoms. […] Symptoms due to high calcium level may vary, depending on the cause and how long the problem has been present. They may include: Digestive symptoms, such as nausea or vomiting, poor appetite, or constipation; Increased thirst or more frequent urination, due to changes in the kidneys; Muscle weakness or twitches; Changes in how your brain works, such as feeling tired or fatigued or confused; Bone pain and fragile bones that break more easily. […] How well you do depends on the cause of your high calcium level. The outlook is good for people with mild hyperparathyroidism or hypercalcemia that have a treatable cause. Most of the time, there are no complications. […] People with hypercalcemia due to conditions such as cancer or sarcoidosis may not do well. This is most often because of the disease itself, rather than the high calcium level.

• #5 Diagnosing a disorder with few symptoms | I.M. Matters from ACP

  https://immattersacp.org/archives/2012/03/hypercalcemia.htm

  Hypercalcemia is much more common in patients with cancer than in the general population. […] Myeloma can initially present with hypercalcemia, and the patient may also have some back pain. […] With more advanced hypercalcemia, the patient may present with some delirium, confusion, and deteriorating kidney function due to dehydration. […] Untreated, severe hypercalcemia will lead to coma and death. […] In-hospital management of this type of hypercalcemia includes replacement of fluids and bisphosphonates. […] Dr. LeGrand also advised that a primary care physician should do additional testing to identify the cause of the condition if a patient presents with hypercalcemia and a low PTH.

• #5 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your doctor tells you that you have hypercalcemia, it means you have too much calcium in your blood. […] You may not notice any symptoms if you have a mild case of hypercalcemia. But as your body tries to get rid of the extra calcium, you might pee a lot and get really thirsty. If your calcium levels are very high, you could get nervous system problems, including becoming confused and even passing out. […] If you don’t get it treated, high levels of calcium in your blood can lead to bone loss, kidney stones, kidney failure, and heart problems. […] If hyperparathyroidism is the cause of your high calcium, you may also get: Depression, Memory loss, Heartburn, Sleep trouble, Bone and muscle pain, Fatigue. […] About 10%-30% of people with cancer may get hypercalcemia. […] Hypercalcemia from cancer can be hard to manage.

• #5 Hypercalcemia in Cats | PetMD

  https://www.petmd.com/cat/conditions/endocrine/hypercalcemia-cats

  Treatment for hypercalcemia depends upon the underlying cause. If a cause can be found and treated, then this should help to prevent future bouts of hypercalcemia. Also, cats showing signs of hypercalcemia and/or have a high calcium level require treatment to lower it. […] After treatment has begun, your veterinarian will perform bloodwork to monitor the calcium level and determine the next steps of treatment. A cat that has previously had hypercalcemia can develop this condition again if the underlying cause is not identified and treated properly, or if treatment is not given as directed.

• #6 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Symptoms of hypercalcemia are nonspecific and are related to the severity and rate of change of the serum calcium level. Symptoms are more severe with acute changes than with chronic calcium level elevation. Patients with a chronic calcium level as high as 12 to 14 mg/dL may tolerate those levels well whereas sudden development of hypercalcemia in this range or higher may lead to dramatic changes in a patient’s mental status. […] A normal extracellular calcium concentration is necessary for normal neuromuscular function. Thus, neurologic dysfunction is the major feature of hypercalcemic states. Patients can experience slight difficulties in concentrating to depression, confusion, and coma. These symptoms may resolve or improve after the hypercalcemia is corrected. Muscle weakness may also occur.

• #6 Assessment of hypercalcaemia – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/159

  Calcium is a critical cation involved in cellular transport, membrane function, and bone metabolism. Hypercalcaemia, or calcium in systemic excess, is harmful to the function of excitable membranes leading to skeletal muscle and gastrointestinal smooth muscle fatigue. Effects on cardiac muscle include a shortened QT interval and increased risk of cardiac arrest at very high calcium levels. Neurological sequelae include depression, irritability, and, with high enough levels, coma. Hypercalcaemia quickly exceeds renal capacity for calcium reabsorption, and calcium spills into urine, complexing with phosphate, leading to nephrolithiasis. Precipitation of calcium salts within the kidney can lead to severe renal damage. […] Hypercalcaemia may be mild and occur without symptoms. History may also identify symptoms of high calcium such as renal stones (typical of hyperparathyroidism), lethargy, easy fatigue, confusion, depression, irritability, constipation, and polyuria and polydipsia. Chronic symptoms are more consistent with hyperparathyroidism, whereas more recent onset of symptoms suggests malignancy. […] Elevated calcium may require an intervention to prevent complications such as osteoporosis. Severe hypercalcaemia is a life-threatening electrolyte emergency requiring prompt recognition and urgent treatment.

• #6 Hypercalcemia (High Level of Calcium in the Blood) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypercalcemia-high-level-of-calcium-in-the-blood

  At first, people have digestive problems, feel thirsty, and may urinate a lot, but if severe, hypercalcemia leads to confusion and eventually coma. If not recognized and treated, the disorder can be life threatening. […] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large amounts of urine, resulting in dehydration and increased thirst. […] Long-term or severe hypercalcemia commonly results in kidney stones containing calcium. Less commonly, kidney failure develops, but it usually resolves with treatment. However, if enough calcium accumulates within the kidneys, damage is irreversible. […] Very severe hypercalcemia often causes brain dysfunction with confusion, emotional disturbances, delirium, hallucinations, and coma. Muscle weakness may occur, and abnormal heart rhythms and death can follow.

• #6 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #6 Management of Hypercalcemia of Malignancy

  https://jhoponline.com/issue-archive/2016-issues/march-vol-6-no-1/management-of-hypercalcemia-of-malignancy

  Patients with mild hypercalcemia, defined as total serum calcium of 10.5 mg/dL to 12 mg/dL or ionized calcium of 5.6 mg/dL to 8 mg/dL, can be asymptomatic. The presenting signs and symptoms of hypercalcemia generally occur when the calcium levels exceed those ranges. Patients whose total serum calcium level is consistently between 12 mg/dL and 14 mg/dL may tolerate this level well, but the sudden development of hypercalcemia in this range or above may lead to dramatic changes in the patient’s mental status. The mnemonic „stones, bones, abdominal moans, and psychic groans” represents the constellation of symptoms and signs of hypercalcemia. The clinical manifestations of hypercalcemia can involve many body systems. Central nervous system effects include lethargy, impaired concentration, fatigue, and muscle weakness. Renal effects include dehydration, polyuria, nephrolithiasis resulting from hypercalciuria, nephrogenic diabetic insipidus, and nephrocalcinosis. Gastrointestinal symptoms include nausea, vomiting, anorexia, weight loss, constipation, abdominal pain, pancreatitis, and peptic ulcer disease. Cardiovascular effects include hypertension, shortened QT interval, cardiac arrhythmia, and vascular calcification. Other symptoms include bone pain, arthritis, and osteoporosis. […] Hypercalcemia is a common complication of cancer. Hypercalcemia of malignancy is a severe complication of cancer that should be treated quickly and appropriately.

• #6 Hypercalcemia – EMCrit Project

  https://emcrit.org/ibcc/hypercalcemia/

  symptoms of hypercalcemia: Neurologic: Delirium, which may progress to stupor and coma. […] symptoms of hypercalcemia: Paresthesia. […] symptoms of hypercalcemia: Muscle weakness, hyporeflexia. […] symptoms of hypercalcemia: Abdominal pain, pancreatitis. […] symptoms of hypercalcemia: Constipation, ileus, nausea/vomiting. […] symptoms of hypercalcemia: Diabetes insipidus (with polyuria and polydipsia). […] symptoms of hypercalcemia: Hypertension (if the patient isn’t hypovolemic). […] Overall, ~90% of hypercalcemia is due to hyperparathyroidism or malignancy. Among critically ill patients (especially those with severe hypercalcemia), malignancy is the most likely cause.

• #6 Hypercalcemia: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14597-hypercalcemia

  Complications of long-term hypercalcemia are rare since calcium levels are checked in routine blood panels and healthcare providers usually catch hypercalcemia early, but complications can include: Calcium deposits in your kidney (nephrocalcinosis) that cause poor kidney function. Kidney failure. Kidney stones. High blood pressure (hypertension). Depression. Bone cysts. Bone fractures. Osteoporosis.

• #6 Hypercalcemia in Cancer: Causes, Symptoms, and Management – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/features/hypercalcemia-in-cancer-causes-symptoms-and-management/

  Hypercalcemia affects up to 30% of patients with cancer. Hypercalcemia can be classified as mild (10.5-11.9 mg/dL), moderate (12.0-13.9 mg/dL), or hypercalcemic crisis (14.0-16.0 mg/dL). Patients with hypercalcemia may present with kidney stones; chronic renal insufficiency; bone pain; excessive urine production; gastrointestinal symptoms such as nausea, vomiting, and constipation; pancreatitis; peptic ulcers; and neuropsychiatric symptoms such as anxiety, depression, lethargy, and confusion. […] Hypercalcemia is the first presenting sign of cancer in some cases of hematologic malignancy, but it often goes unrecognized by non-oncologists. Patients may have very vague symptoms and think they are just tired and dehydrated. […] For patients in remission, if calcium levels are higher than expected, this might be a sign of the cancer coming back, especially if patients are also complaining of weakness and confusion. […] Given the low survival rates associated with cancer-related hypercalcemia, providers may need to consider engaging palliative care services in some cases.

• #6 Hypercalcemia – USZ

  https://www.usz.ch/en/disease/hypercalcemia/

  If the values rise to 3 mmol/l and above, severe symptoms occur. We refer to a hypercalcemic crisis at a level of 3.5 mmol/l, which is an emergency and requires immediate treatment. The condition is life-threatening. […] The course and prognosis for hypercalcemia depend on the severity and cause of the calcium levels. Usually, the prognosis is favorable if we quickly lower the calcium level sufficiently. It should be noted that hypercalcemia is often associated with severe, advanced cancer. This also influences life expectancy. Age, the use of medication and other existing diseases also have an influence on the course and prognosis.

• #6 Neonatal Hypercalcemia – Pediatrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pediatrics/metabolic-electrolyte-and-toxic-disorders-in-neonates/neonatal-hypercalcemia

  Hypercalcemia is total serum calcium 12 mg/dL ( 3 mmol/L) or ionized calcium 6 mg/dL ( 1.5 mmol/L). Gastrointestinal signs may occur (eg, anorexia, vomiting, constipation) and sometimes lethargy or seizures. […] Symptoms and signs of neonatal hypercalcemia may be noted when total serum calcium is 12 mg/dL ( 3 mmol/L). These signs can include anorexia, gastroesophageal reflux, nausea, vomiting, lethargy or seizures or generalized irritability, and hypertension. Other symptoms and signs include constipation, abdominal pain, dehydration, feeding intolerance, and failure to thrive. Some neonates have weakness. […] With subcutaneous fat necrosis, firm purple nodules may be observed on the trunk, buttocks, or legs.

• #6 Delirium Caused by Hypercalcemia in Older Adults – European Journal of Geriatrics and Gerontology

  https://ejgg.org/articles/delirium-caused-by-hypercalcemia-in-older-adults/doi/ejgg.galenos.2023.2021-11-5

  When plasma calcium levels are between 10.5-12.0 mg/dL, more than half of the cases are asymptomatic. When calcium levels exceed 13 mg/dL, symptoms and findings that negatively affect many systems are seen. Neuropsychiatric symptoms such as impaired concentration and increased sleep duration may occur initially due to hypercalcemia. As the calcium level increases, depression, delirium, confusion, and then coma may develop. […] In our patient, we think that delirium development was caused by hypercalcemia and dehydration. Delirium disappeared after hydration and serum calcium levels were restored to within normal limits. Delirium is multifactorial, and causes serious problems for affected patients, family members, caregivers and healthcare providers. The general purpose of delirium treatment is therefore early diagnosis and treatment with a multidisciplinary approach, which are of great importance in appropriate cases with delirium.

• #6 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #6 Hypercalcemia: Symptoms, Causes & Effective Treatments

  https://www.bajajallianz.com/blog/wellness/hypercalcemia-symptoms-diagnosis-and-treatment.html

  The symptoms of hypercalcemia can vary depending on the severity of the condition. In mild cases, there may be no noticeable symptoms, while severe hypercalcemia can result in life-threatening complications. Common symptoms include: […] If you notice any of these symptoms, it is important to consult with a healthcare provider for further evaluation and management. […] Early treatment helps in preventing complications such as kidney damage, bone thinning, and heart problems. If you suspect you have hypercalcemia, it is important to consult a healthcare provider promptly. […] Untreated hypercalcemia can lead to kidney failure, heart arrhythmias, bone loss, and even coma. It is essential to address the condition early to avoid these severe complications.

• #7 Clinical manifestations of hypercalcemia – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-of-hypercalcemia

  Moderate hypercalcemia – A moderately elevated serum calcium of 12 to 14 mg/dL (3 to 3.5 mmol/L) may be well tolerated chronically, while an acute rise to these concentrations may cause marked symptoms, including polyuria, polydipsia, dehydration, anorexia, nausea, muscle weakness, and changes in sensorium.

• #7 Assessment of hypercalcaemia – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/159

  Calcium is a critical cation involved in cellular transport, membrane function, and bone metabolism. Hypercalcaemia, or calcium in systemic excess, is harmful to the function of excitable membranes leading to skeletal muscle and gastrointestinal smooth muscle fatigue. Effects on cardiac muscle include a shortened QT interval and increased risk of cardiac arrest at very high calcium levels. Neurological sequelae include depression, irritability, and, with high enough levels, coma. Hypercalcaemia quickly exceeds renal capacity for calcium reabsorption, and calcium spills into urine, complexing with phosphate, leading to nephrolithiasis. Precipitation of calcium salts within the kidney can lead to severe renal damage. […] Hypercalcaemia may be mild and occur without symptoms. History may also identify symptoms of high calcium such as renal stones (typical of hyperparathyroidism), lethargy, easy fatigue, confusion, depression, irritability, constipation, and polyuria and polydipsia. Chronic symptoms are more consistent with hyperparathyroidism, whereas more recent onset of symptoms suggests malignancy. […] Elevated calcium may require an intervention to prevent complications such as osteoporosis. Severe hypercalcaemia is a life-threatening electrolyte emergency requiring prompt recognition and urgent treatment.

• #7 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #7 Hypercalcemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430714/

  Hypercalcemia is often an incidental finding detected on labwork completed for other reasons. When calcium levels rise above 12 mg/dL, patients typically present with clinical signs and symptoms, including polyuria, polydipsia, constipation, weakness, neuropsychiatric effects, nausea, vomiting, fatigue, anorexia, and confusion. These symptoms occur mainly due to several factors, such as suppressed neural transmission, loss of the kidney’s concentrating ability, other renal dysfunction, and effects on the central nervous system. […] Cardiac tissue also relies on calcium homeostasis, and hypercalcemia can lead to shortened QT intervals, prolonged PR intervals, and widened QRS complex on electrocardiogram (ECG). Cardiac manifestations include bradycardia, heart block, and other arrhythmias, which can be life-threatening. At severe levels, hypercalcemia can even lead to stupor or coma. Chronically high levels of hypercalcemia can also cause calcium renal stones, pancreatitis, and peptic ulcers. Patients with hypercalcemia due to hyperparathyroidism can present with fractures from osteopenia and osteoporosis. The collective symptoms of hypercalcemia are often summarized by the phrases groans, bones, stones, moans, thrones, and psychiatric overtones.

• #7 A Practical Approach to Hypercalcemia | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0501/p1959.html

  Hypercalcemia is a disorder commonly encountered by primary care physicians. Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. […] Hypercalcemia leads to hyperpolarization of cell membranes. Patients with levels of calcium between 10.5 and 12 mg per dL can be asymptomatic. When the serum calcium level rises above this stage, multisystem manifestations become apparent. This constellation of symptoms has led to the mnemonic Stones, bones, abdominal moans, and psychic groans, which is used to recall the signs and symptoms of hypercalcemia, particularly as a result of primary hyperparathyroidism. […] Neuromuscular effects include impaired concentration, confusion, corneal calcification, fatigue, and muscle weakness. Nausea, abdominal pain, anorexia, constipation, and, rarely, peptic ulcer disease or pancreatitis are among the gastrointestinal manifestations. The most important renal effects are polydipsia and polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria. Other renal effects include dehydration and nephrocalcinosis. Cardiovascular effects include hypertension, vascular calcification, and a shortened QT interval on the electrocardiogram.

• #7 FF #151 Hypercalcemia of Malignancy | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/hypercalcemia-of-malignancy/

  Background Up to 30 percent of patients with cancer develop hypercalcemia. Approximately 50% of these patients will die within 30 days of a hypercalcemia diagnosis, even if the hypercalcemia is corrected, which suggests that hypercalcemia is a sign of a hormonally advanced cancer. It is most associated with squamous cell cancers of lung, head and neck, and esophagus, breast cancer, renal cell carcinoma, lymphomas and multiple myeloma. […] Symptoms/Signs Symptoms roughly correlate with the degree of hypercalcemia (corrected) and the rapidity of rise: Mild (10.5-11.9 mg/dl); Moderate (12-13.9 mg/dl); Severe (>14 mg/dl). […] Neurologic: fatigue, sedation, delirium, coma. […] Gastrointestinal: anorexia, nausea, vomiting, constipation. […] Renal: dehydration, polyuria, thirst/polydipsia, nephrolithiasis, renal dysfunction.

• #7 Hyperparathyroidism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism

  For people with primary hyperparathyroidism, parathyroidectomy is very effective at bringing calcium levels back to normal, and at improving bone density and symptoms. Studies suggest that, after surgery, over 80% of people (4 out of 5) saw symptom improvement, and over 90% (9 out of 10) had calcium levels return to normal and bone density improve. […] Kidney transplant improves secondary hyperparathyroidism in about 40% of people within a year.

• #7 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your doctor tells you that you have hypercalcemia, it means you have too much calcium in your blood. […] You may not notice any symptoms if you have a mild case of hypercalcemia. But as your body tries to get rid of the extra calcium, you might pee a lot and get really thirsty. If your calcium levels are very high, you could get nervous system problems, including becoming confused and even passing out. […] If you don’t get it treated, high levels of calcium in your blood can lead to bone loss, kidney stones, kidney failure, and heart problems. […] If hyperparathyroidism is the cause of your high calcium, you may also get: Depression, Memory loss, Heartburn, Sleep trouble, Bone and muscle pain, Fatigue. […] About 10%-30% of people with cancer may get hypercalcemia. […] Hypercalcemia from cancer can be hard to manage.

• #8 Hypercalcemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/240681-overview

  Hypercalcemia can result when too much calcium enters the extracellular fluid or when there is insufficient calcium excretion from the kidneys. Approximately 90% of cases of hypercalcemia are caused by hyperparathyroidism or malignancy. […] The severity of symptoms is related not only to the absolute calcium level but also to how fast the rise in serum calcium occurred. Mild prolonged hypercalcemia may produce mild or no symptoms, or recurring problems such as kidney stones. Sudden-onset and severe hypercalcemia may cause dramatic symptoms, usually including confusion and lethargy, possibly leading quickly to death. Serum calcium levels greater than approximately 15 mg/dL usually are considered to be a medical emergency and must be treated aggressively. […] Hypercalcemia affects nearly every organ system in the body, but it particularly affects the central nervous system (CNS) and the kidneys. CNS effects include the following: Lethargy, Muscle weakness, Bone pain, Confusion, Stupor, Coma.

• #8 Hypercalcemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523

  Hypercalcemia is a condition in which the calcium level in the blood becomes too high. Too much calcium in the blood can weaken bones and create kidney stones. It also can affect the heart and brain. […] Some people have no symptoms of this condition. Others have symptoms that range from mild to serious. Treatment depends on the cause. […] You might not have any symptoms if your hypercalcemia is mild. If it’s more serious, your symptoms are related to the parts of your body affected by high blood calcium levels. Examples include: […] Excess calcium makes the kidneys work harder to filter it. This can cause serious thirst and frequent urination. […] Hypercalcemia can cause stomach upset or pain, vomiting, and constipation. […] Most often, the extra calcium in the blood is leached from the bones. This weakens the bones. It can cause bone pain and muscle weakness.

• #8 Disease Management: Hypercalcemia

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/hypercalcemia/default.htm

  Chronic hypercalcemia may result in the formation of renal calculi. Hypercalciuria is the main factor in stone formation, but increased calcitriol production in primary HPT also plays a role. Nephrogenic diabetes insipidus resulting in polydipsia and polyuria is seen in about 20% of patients. […] Hypertension can develop in patients with hypercalcemia as a result of renal insufficiency, calcium-mediated vasoconstriction, or both. Hypertension may or may not resolve after the hypercalcemia is corrected. […] Constipation, anorexia, nausea, and vomiting are often prominent symptoms whereas acute pancreatitis and peptic ulcer disease are unusual. Fatigue, musculoskeletal weakness, and pain are the only symptoms that correlate with increasing levels of serum calcium. […] Hypercalcemic crisis is a rare manifestation and is characterized by calcium levels above 15 mg/dL and severe symptoms, particularly central nervous system dysfunction. Abdominal pain, pancreatitis, peptic ulcer disease, nausea, and vomiting are common in these patients. The mechanism whereby a crisis develops is not clear, but dehydration, intercurrent illness, and infarction of a parathyroid adenoma may play a role.

• #8 Hypercalcemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypercalcemia

  Hypercalcemia is a total serum calcium concentration 10.4 mg/dL ( 2.60 mmol/L) or ionized serum calcium 5.2 mg/dL ( 1.30 mmol/L). Clinical features include polyuria, constipation, muscle weakness, confusion, and coma. […] In mild hypercalcemia, many patients are asymptomatic. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal pain, and ileus. Impairment of the renal concentrating mechanism leads to polyuria, nocturia, and polydipsia. Elevation of serum calcium 12 mg/dL ( 3.00 mmol/L) can cause emotional lability, confusion, delirium, psychosis, stupor, and coma. Hypercalcemia may cause neuromuscular symptoms, including skeletal muscle weakness. Hypercalciuria with nephrolithiasis is common. […] Less often, prolonged or severe hypercalcemia causes reversible acute kidney injury or irreversible kidney damage due to nephrocalcinosis (precipitation of calcium salts within the kidney parenchyma). […] In severe hypercalcemia a shortened QTc interval is shown on ECG, and arrhythmias may occur, particularly in patients taking digoxin. Hypercalcemia 18 mg/dL ( 4.50 mmol/L) may cause shock, renal failure, and death.

• #8 Patient Care Spotlight: Current Management of Hypercalcemia Associated With Multiple Myeloma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/for-physicians/clinical-resources/hematologic-malignancies/advances-newsletter/2013-issue-2/patient-care-spotlight-hypercalcemia-multiple-myeloma

  Patients with multiple myeloma are commonly diagnosed with hypercalcemia. In fact, hypercalcemia is one of the four diagnostic „CRAB” criteria (calcium elevation, renal insufficiency, anemia, or bone disease) used to distinguish smoldering myeloma and monoclonal gammopathies of undetermined significance from active, symptomatic multiple myeloma. About 10 to 15 percent of patients with multiple myeloma present with hypercalcemia at the time of initial diagnosis, while more than 25 percent will be found to have hypercalcemia at some point during the trajectory of their disease, usually at the time of disease progression and relapse. […] Symptoms associated with hypercalcemia may be subtle or dramatic, and can include: nausea and vomiting; confusion or depression; myalgias and arthralgias; dry mouth; polydipsia; anorexia; constipation; abdominal pain; and, eventually, coma. In patients with myeloma, a hypercalcemia diagnosis is often indicative of uncontrolled disease. […] Hypercalcemia is usually an ominous indication that either the myeloma disease has relapsed or that the patient is not responding to current therapy. It is, therefore, important to give systemic myeloma therapy as soon as possible to prevent recurrence of hypercalcemia.

• #8 Hypercalcemia: Symptoms, Causes & Effective Treatments

  https://www.bajajallianz.com/blog/wellness/hypercalcemia-symptoms-diagnosis-and-treatment.html

  The symptoms of hypercalcemia can vary depending on the severity of the condition. In mild cases, there may be no noticeable symptoms, while severe hypercalcemia can result in life-threatening complications. Common symptoms include: […] If you notice any of these symptoms, it is important to consult with a healthcare provider for further evaluation and management. […] Early treatment helps in preventing complications such as kidney damage, bone thinning, and heart problems. If you suspect you have hypercalcemia, it is important to consult a healthcare provider promptly. […] Untreated hypercalcemia can lead to kidney failure, heart arrhythmias, bone loss, and even coma. It is essential to address the condition early to avoid these severe complications.

• #9 Hypercalcaemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypercalcaemia

  Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range for total calcium is 2.12.6 mmol/L (8.810.7 mg/dL, 4.35.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. 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. […] Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/L). Severe hypercalcaemia (above 1516 mg/dL or 3.754 mmol/L) is considered a medical emergency: at these levels, coma and cardiac arrest can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor or coma. In the gut this causes constipation. […] A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/L). The main symptoms of a hypercalcaemic crisis are oliguria or anuria, as well as somnolence or coma.

• #9 Hypercalcemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypercalcemia

  Hypercalcemia is a total serum calcium concentration 10.4 mg/dL ( 2.60 mmol/L) or ionized serum calcium 5.2 mg/dL ( 1.30 mmol/L). Clinical features include polyuria, constipation, muscle weakness, confusion, and coma. […] In mild hypercalcemia, many patients are asymptomatic. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal pain, and ileus. Impairment of the renal concentrating mechanism leads to polyuria, nocturia, and polydipsia. Elevation of serum calcium 12 mg/dL ( 3.00 mmol/L) can cause emotional lability, confusion, delirium, psychosis, stupor, and coma. Hypercalcemia may cause neuromuscular symptoms, including skeletal muscle weakness. Hypercalciuria with nephrolithiasis is common. […] Less often, prolonged or severe hypercalcemia causes reversible acute kidney injury or irreversible kidney damage due to nephrocalcinosis (precipitation of calcium salts within the kidney parenchyma). […] In severe hypercalcemia a shortened QTc interval is shown on ECG, and arrhythmias may occur, particularly in patients taking digoxin. Hypercalcemia 18 mg/dL ( 4.50 mmol/L) may cause shock, renal failure, and death.

• #9 Diagnosing a disorder with few symptoms | I.M. Matters from ACP

  https://immattersacp.org/archives/2012/03/hypercalcemia.htm

  Hypercalcemia is much more common in patients with cancer than in the general population. […] Myeloma can initially present with hypercalcemia, and the patient may also have some back pain. […] With more advanced hypercalcemia, the patient may present with some delirium, confusion, and deteriorating kidney function due to dehydration. […] Untreated, severe hypercalcemia will lead to coma and death. […] In-hospital management of this type of hypercalcemia includes replacement of fluids and bisphosphonates. […] Dr. LeGrand also advised that a primary care physician should do additional testing to identify the cause of the condition if a patient presents with hypercalcemia and a low PTH.

• #10 Hypercalcemia – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypercalcemia

  Hypercalcemia is a total serum calcium concentration 10.4 mg/dL ( 2.60 mmol/L) or ionized serum calcium 5.2 mg/dL ( 1.30 mmol/L). Clinical features include polyuria, constipation, muscle weakness, confusion, and coma. […] In mild hypercalcemia, many patients are asymptomatic. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal pain, and ileus. Impairment of the renal concentrating mechanism leads to polyuria, nocturia, and polydipsia. Elevation of serum calcium 12 mg/dL ( 3.00 mmol/L) can cause emotional lability, confusion, delirium, psychosis, stupor, and coma. Hypercalcemia may cause neuromuscular symptoms, including skeletal muscle weakness. Hypercalciuria with nephrolithiasis is common. […] Less often, prolonged or severe hypercalcemia causes reversible acute kidney injury or irreversible kidney damage due to nephrocalcinosis (precipitation of calcium salts within the kidney parenchyma). […] In severe hypercalcemia a shortened QTc interval is shown on ECG, and arrhythmias may occur, particularly in patients taking digoxin. Hypercalcemia 18 mg/dL ( 4.50 mmol/L) may cause shock, renal failure, and death.

• #10 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your calcium levels are very high, for any reason, you’ll need to go to the hospital to get fluids and medicine called diuretics through your veins. This can treat hypercalcemia quickly. […] Severe hypercalcemia is especially hard on your kidneys and heart. It can cause kidney failure and problems with your heart rhythms.

• #11 What Causes Hypercalcemia? Here Are 7 Known Causes

  https://www.webmd.com/a-to-z-guides/hypercalcemia-causes

  If your calcium levels are very high, for any reason, you’ll need to go to the hospital to get fluids and medicine called diuretics through your veins. This can treat hypercalcemia quickly. […] Severe hypercalcemia is especially hard on your kidneys and heart. It can cause kidney failure and problems with your heart rhythms.

• #12 Hypercalcemia (High Level of Calcium in the Blood) – Hormonal and Metabolic Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypercalcemia-high-level-of-calcium-in-the-blood

  At first, people have digestive problems, feel thirsty, and may urinate a lot, but if severe, hypercalcemia leads to confusion and eventually coma. If not recognized and treated, the disorder can be life threatening. […] Hypercalcemia often causes few symptoms. The earliest symptoms of hypercalcemia are usually constipation, nausea, vomiting, abdominal pain, and loss of appetite. People may excrete abnormally large amounts of urine, resulting in dehydration and increased thirst. […] Long-term or severe hypercalcemia commonly results in kidney stones containing calcium. Less commonly, kidney failure develops, but it usually resolves with treatment. However, if enough calcium accumulates within the kidneys, damage is irreversible. […] Very severe hypercalcemia often causes brain dysfunction with confusion, emotional disturbances, delirium, hallucinations, and coma. Muscle weakness may occur, and abnormal heart rhythms and death can follow.

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