Hypercalcemia: Causes, Symptoms & Treatment

In contrast to a calcium deficiency, hypercalcemia or hypercalcemia is an elevated level of calcium in the blood. To avoid more extensive disorders, it is advisable to consult a physician in this regard for further diagnosis and treatment.

What is hypercalcemia?

Hypercalcemia is defined as an excessive level of calcium in the blood. Levels greater than 2.7 mmol/l in humans for total calcium in the bloodstream are considered crucial in this case. In the case of ionized (free) calcium, a value of more than 1.3 mmol/l is referred to as hypercalcemia. A full-blown calcemic crisis is said to occur when the total level has risen above 3.5 mmol/l. Then there is polyuria (greatly increased urine excretion), vomiting, dehydration, fever and psychosis. Eventually, coma may result.

Causes

Disruption of calcium metabolism can have many causes:

The most common cause is malignant tumors, most commonly bronchial carcinomas, breast cancer, and so-called multiple myeloma, a cancer of the bone marrow. In second place would be osteolytic hypercalcemia. This is particularly the case with bone metastases and plasmocytomas. Here, the cancer cells release substances that have an increasing effect on calcium metabolism. Thirdly, there is paraneoplastic hypercalcemia. It is caused by peptides that are similar to parathyroid hormone. These peptides are produced by tumors. Approximately 90% of all patients with this form of hypercalcemia have such peptides in their blood, whether or not bone metastases are present. In dogs, hypercalcemia most commonly arises from tumors of the anal glands. Another cause is hyperparathyroidism, which affects about 20% of hypercalcemia patients. Adrenal insufficiency (Addison’s disease), hyperthyroidism (hyperthyroidism) and multiple endocrine neoplasia (MEN) are also among the possible causes. Symptoms of poisoning continue the list of factors from which hypercalcemia could result. These include, first of all, poisoning with vitamins, in other words, excessive doses of certain vitamins, especially vitamins A, D and D3. It should be noted that, unfortunately, in ready-made food and supplementary food for dogs and cats, superfluously high amounts of these vitamins can be found. In humans, an overdose is therefore rather rare. Intoxication by tamoxifen and certain diuretics can also be responsible, at least temporarily, for excessively high blood calcium levels. Furthermore, an increased intake of lithium, calcium-containing ion exchangers, teriparatides and theophylline. Immobilization, i.e. immobilization of certain parts of the body (plaster leg) or bed rest, also leads to hypercalcemia. Other causes that are not very significant in percentage terms:

  • Sarcoidosis (which are nodules of tissue, usually in the lungs).
  • Hypercalcemia secondary to renal transplantation. Here, temporary renal insufficiency may have caused the parathyroid gland to become hyperactive.
  • Furthermore, an overdose of calcium, for example, by a high consumption of dairy products or an excessive intake of supplements.
  • Hereditary hypercalcemia due to deficient renal calcium excretion.
  • Acromegaly (a growth disorder caused by overproduction of growth hormone).
  • Pheochromocytoma (an accessory formation of the adrenal gland that can be malignant or benign).
  • Hypophosphatasia (an extremely rare inherited disorder of bone metabolism).

Symptoms, complaints and signs

The symptomatology of hypercalcemia depends on the level of calcium concentration in the blood. Most often, nonspecific symptoms occur, which are also present in other diseases. Therefore, hypercalcemia is often discovered only by chance during an examination. If there is only a slight excess of calcium, often no symptoms are observed at all. Otherwise, the disease is characterized by a variety of different complaints that can affect the heart, kidneys, digestive system, nervous system and muscles. Thus, cardiac arrhythmias may occur. Furthermore, the body often reacts with nausea, vomiting, constipation and loss of appetite. Kidney stones and calcium salts can be deposited in the kidneys. The kidney stones can remain silent as well as lead to renal colic.Furthermore, there is often an increased excretion of urine with a simultaneous strong feeling of thirst. If the musculature is involved, muscle weakness develops with a decrease in general performance. If the nervous system is affected, drowsiness and even disturbances of consciousness often occur. Furthermore, the development of a so-called brain-organic syndrome with behavioral abnormalities, memory disorders, anxiety, lack of interest and fatigue is possible. If the calcium level exceeds 3.5 millimoles of calcium per liter of blood, a life-threatening hypercalcemic crisis occurs. The hypercalcemic crisis develops within a few days and, in addition to nausea and vomiting, is characterized by severe cardiac arrhythmias, fever, exsiccosis (dehydration), increased fluid loss due to polyuria, and impaired consciousness up to and including coma. Hypercalcemic crisis leads to death in 50 percent of cases.

Diagnosis and course

Symptoms are absent in half of all patients with hypercalcemia. Often, the phenomenon is discovered only incidentally during a blood test. Otherwise, symptoms of the underlying disease are seen, as well as increased water excretion, nausea, constipation, vomiting, sometimes pancreatitis, cardiac arrhythmias, listlessness, muscle weakness, extreme drowsiness, psychosis, and coma. Diagnosis is made primarily by laboratory examination of the blood and by looking for causative parameters, such as tumors, as well as an examination of parathyroid hormone, calcitriol, and PTHrP levels.

Complications

The excess of calcium in the body can cause various complaints and complications in the patient. To avoid long-term damage, a physician should be consulted in all cases. In most cases, no clear diagnosis can be drawn for a relatively long time, because hypercalcemia does not present clear symptoms and complaints. As a rule, frequent urination occurs and the affected person suffers from vomiting and nausea. In some cases, it can lead to complaints of the heart, so that the affected person is no longer able to work under pressure and usually feels fatigued and listless. There is also a general feeling of sickness and weakness. The muscles are also weak and can no longer be used in the usual way. It is not uncommon for constipation to occur as well. The symptoms can thus extremely limit and complicate the patient’s daily life. The treatment of hypercalcemia always depends on the causes of the disease. As a rule, acute emergencies can also be treated with the help of solutions and infusions. No further complications occur in this case.

When should you go to the doctor?

Hypercalcemia does not always cause obvious symptoms. A doctor should be seen if increased urination is noticed. Frequent urination is often associated with nausea and vomiting, constipation, and fatigue. When these symptoms occur, medical advice is needed. At the latest when signs of cardiac arrhythmia or muscle weakness are noticed, the complaints must be taken to the family doctor. If the calcium overload remains untreated, it can lead to circulatory collapse or even a heart attack. A doctor should therefore be consulted at an early stage so that the symptoms can be clarified and, if necessary, treated before serious complications develop. Should a circulatory collapse or other medical emergency occur, the emergency physician must be called. The affected person requires immediate medical treatment and must then be cared for in the hospital. In the case of hypercalcemia, a general practitioner or internist is usually consulted. If the bones are involved, an orthopedist must be consulted concomitantly. The initial diagnosis may be made by the primary care physician.

Treatment and therapy

As therapy, an attempt is made to eliminate the causes. For example, by surgical removal of a tumor. Otherwise, dietary calcium intake will be attempted to be stopped as much as possible. Acute symptom control can be achieved by means of the supply of a physiological saline solution and furosemide and simultaneously initiated water excretion. In the presence of tumors, bisphosphonates may be given to limit osteoclast function. In addition, the administration of glucocorticoids may be helpful because they act against vitamin D.In the case of renal insufficiency, dialysis may also be considered. For very rapid lowering of calcium levels as an emergency measure, the hormone calcitonin can be administered.

Outlook and prognosis

The prospect of cure in hypercalcemia depends on the causative trigger of the excess calcium in the organism. In severe cases, a tumor disease is present. If this can be successfully removed and no metastases form in the body, there is a prospect of a cure for hypercalcemia. If an aggressive tumor is diagnosed that cannot be adequately treated, hypercalcemia will be present until the end of the patient’s life. In these cases, severe symptoms of the affected person are treated, but no cure of concomitant symptoms is sought. In less dramatic cases, a significant alleviation of symptoms as well as a cure can be achieved with just a change in food intake. With a balanced and healthy food supply, there is a continuous reduction of the excess calcium until a complete normalization occurs. A permanent cure is possible if the elaborated diet is also applied in the long term. In acute health conditions, an infusion can be used to reduce calcium levels. However, this is not a permanent measure that results in freedom from symptoms. Only a removal of the current calcium level in the organism takes place. Without a treatment of the cause, there is subsequently a reformation of the nutrient and thus an immediate relapse of the complaints.

Prevention

Hypercalcemia can be prevented only to a limited extent, since it can be a concomitant of several other diseases. One possibility is to largely refrain from taking calcium and vitamin D3 with food. However, this should only be done after consultation with a physician, since these substances are, on the other hand, also essential for life.

Aftercare

In most cases, no special measures of aftercare are available to the affected person in the case of hypercalcemia. In this case, the disease must first and foremost be recognized and treated correctly and, above all, at an early stage by a physician, so that there are no further complications and also no further worsening of the symptoms. In most cases, the intake through food can be controlled, so that the affected person must adjust his diet correctly. The doctor can also be of assistance in this and draw up a diet plan for the affected person. The patient should also drink plenty of water to eliminate the excess calcium. After successful treatment, care should be taken not to trigger the hypercalcemia again. The reason for the hypercalcemia should also be identified so that it does not recur. In severe cases or in cases of severe intoxication, drugs can be taken to lower the level of calcium. If treated quickly, hypercalcemia does not result in a decreased life expectancy for the affected person.

Here’s what you can do yourself

Hypercalcemia can have quite different causes and is not diagnosed by the patient himself. Most often, it comes to light during the examination of blood values, which takes place as part of another diagnostic procedure. First and foremost, it is important to find out what the causes of hypercalcemia are in order to be able to choose a correct and appropriate form of therapy. The patient cannot contribute too much to this, but he can speed up the process by his willingness to cooperate and by answering questions precisely. The patient contributes to his recovery by trusting and following the therapy plan drawn up and the advice of his attending physician. If there are any deviations, he should report them to the doctor as soon as possible, as well as any other peculiarities he notices. Parallel to the therapy, the patient can support his recovery by maintaining as healthy and stable a lifestyle as possible. Sufficient sleep and also occasional rest during the day support balance and a good general condition. Reducing excess weight and adjusting eating habits to a healthy and balanced diet also do much to improve health. If the overall condition permits, a moderate sports and exercise program is also very beneficial for the condition and the cardiovascular system.Basically, the better the general condition, the better the chances of recovery.