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Hypercalcemia (High Level of Calcium in the Blood)

by James L. Lewis, III, MD

In hypercalcemia, the level of calcium in blood is too high.

  • A high calcium level may result from a problem with the parathyroid glands, as well as from diet, cancer, or disorders affecting bone.

  • 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.

  • Usually, the disorder is detected by routine blood tests.

  • Drinking lots of fluids may be sufficient, but diuretics may increase calcium excretion and drugs can be used to slow the release of calcium from bone if needed.

The body carefully controls the amount of calcium circulating in the blood (see Overview of Calcium).

Causes

Causes of hypercalcemia include the following:

  • Hyperparathyroidism: One or more of the four parathyroid glands secrete too much parathyroid hormone, which helps control the amount of calcium in blood.

  • Too much calcium: Occasionally, hypercalcemia develops in people with peptic ulcers if they drink a lot of milk and take calcium-containing antacids for relief. The resulting disorder is called the milk-alkali syndrome.

  • Too much vitamin D: If people take very high daily doses of vitamin D over several months, the amount of calcium absorbed from the digestive tract increases substantially.

  • Cancer: Cells in kidney, lung, and ovary cancers may secrete large amounts of a protein that, like parathyroid hormone, increases the calcium level in blood. These effects are considered a paraneoplastic syndrome (see Paraneoplastic Syndromes). Calcium can also be released into blood when cancer spreads (metastasizes) to bone and destroys bone cells. Such bone destruction occurs most commonly with prostate, breast, and lung cancers. Multiple myeloma (a cancer involving bone marrow) can also lead to the destruction of bone and result in hypercalcemia. Other cancers can increase the calcium level in blood by means not yet fully understood.

  • Bone disorders: If bone is broken down (resorbed) or destroyed, calcium is released into the blood, sometimes causing hypercalcemia. In Paget disease, bone is broken down, but the calcium level in blood is usually normal. However, the calcium level can become too high if people with Paget disease become dehydrated or spend too much time sitting or lying down—when the bones are not bearing weight.

  • Inactivity: Rarely, people who are immobilized, such as those who are paralyzed, or people who must remain in bed for a long time, develop hypercalcemia because calcium in bone is released into the blood when bones do not bear weight for long periods of time.

Did You Know...

  • Lack of mobility can make the calcium level high because bones weaken and release calcium into the blood.

Symptoms and Diagnosis

Hypercalcemia often causes no symptoms. The earliest symptoms 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.

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. 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.

Hypercalcemia is usually detected during routine blood tests.

Treatment

If hypercalcemia is not severe, correcting the cause is often sufficient. If people have mild hypercalcemia or conditions that can cause hypercalcemia and if their kidney function is normal, they are usually advised to drink plenty of fluids. Fluids stimulate the kidneys to excrete calcium and help prevent dehydration. Doctors may advise people to take mineral supplements containing phosphate, which helps prevent calcium absorption.

If the calcium level is very high or if symptoms of brain dysfunction or muscle weakness appear, fluids and diuretics are given intravenously as long as kidney function is normal. Dialysis is a highly effective, safe, reliable treatment, but it is usually used only for people with severe hypercalcemia that cannot be treated by other methods.

Several other drugs (including bisphosphonates, calcitonin, corticosteroids, and, rarely, plicamycin) can be used to treat hypercalcemia. These drugs work primarily by slowing the release of calcium from bone.

Hypercalcemia caused by cancer is particularly difficult to treat. If the cancer cannot be controlled, hypercalcemia usually returns despite the best treatment.

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