Hypercalcemia: Difference between revisions
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== | == Introduction == | ||
Hypercalcemia is a condition in which the calcium level in the [[Blood Physiology|blood]] is above normal. Too much calcium in your blood can weaken the [[bone]]<nowiki/>s, create [[Kidney Stones|kidney stone]]<nowiki/>s, and interfere with how the [[Anatomy of the Human Heart|heart]] and [[Brain Anatomy|brain]] work. | |||
Hypercalcemia is | Hypercalcemia is usually a result of overactive parathyroid glands. Other causes of hypercalcemia include [[Oncology|cancer]], certain other medical disorders, some medications, and taking too much of calcium and [[Vitamin D Deficiency|vitamin D]] supplements<ref>Mayo clinic [https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523 Hypercalcemia] Available: https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523<nowiki/>(accessed 2.4.2022)</ref>. | ||
= | * Signs and symptoms of hypercalcemia range from nonexistent to severe. Treatment depends on the cause. | ||
* Normal calcium levels range from 8.2-10.2 mg/dL. Mild hypercalcemia occurs when this level raises to 12mg/dL and severe hypercalcemia is classified as serum calcium at 14mg/dL.<ref name="p1">Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, MO: Elsevier Saunders; 2013.</ref> | |||
== Epidemiolgy == | |||
< | The prevalence of hypercalcemia in the general population is approximately 1% to 2%. Most of the cases (90%) of hypercalcemia are due to primary [[hyperparathyroidism]] and malignancy-associated hypercalcemia<ref name=":0">Sadiq NM, Naganathan S, Badireddy M. [https://www.ncbi.nlm.nih.gov/books/NBK430714/ Hypercalcemia.][Updated August 11, 2021]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021. Available;https://www.ncbi.nlm.nih.gov/books/NBK430714/ (accessed 2.4.2022)</ref>. | ||
== Etiology == | |||
Common causes of hypercalcemia include: <ref name="p5">Hypercalcemia: Causes [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=treatments%2Dand%2Ddrugs</ref> | |||
*Overactivity of parathyroid glands | |||
*Cancer-specifically [[Lung Cancer|lung]] and [[Breast Cancer|breast cancer]] as well as [[Multiple Myeloma|multiple myeloma]] can increase the risk of hypercalcemia. This is considered to be due to the fact that some malignant tumors can produce a [[Proteins|protein]] that acts similar to the parathyroid hormone which stimulates the release of calcium from the bones into the bloodstream. | |||
*Other disease effects-some people with cancer that causes them to spend increased time lying down or in bed may cause bones to release calcium into the blood due to the lack of weight-bearing. | |||
*Medications-Lithium, a drug used to treat [[Bipolar Disorder|bipolar disorder]], may increase the release of parathyroid hormone and cause hypercalcemia. Also, Thiazie [[Diuretics|diuretic]]<nowiki/>s can cause elevated calcium levels by decreasing the amount of calcium excreted in the urine. | |||
*Supplements-eating or drinking too much calcium or Vitamin D | |||
*[[Dehydration]]-less fluid in your blood causes the calcium levels to increase | |||
== Characteristics/Clinical Presentation == | |||
Many of the symptoms of hypercalcemia are ones that are characteristic of other conditions. More-severe cases produce signs and symptoms related to the parts of the body affected by the high calcium levels in the blood. Examples include: | |||
| | * Gastrointestinal symptoms like pain, nausea, and vomiting. Hypercalcemia can lead to [[Peptic Ulcers|peptic ulcer]] disease and [[pancreatitis]]. | ||
* | * Bone related complications like bone pain. Hypercalcemia can lead to [[osteoporosis]], [[osteomalacia]], [[arthritis]] and [[Insufficiency Fracture|pathological fractures]]. | ||
* | * Renal stones causing pain. | ||
* | * Fatigue and malaise. | ||
* | * Polyuria, polydipsia, and constipation. | ||
* Lethargy, confusion, [[depression]] and [[memory]] loss. | |||
< | Severe hypercalcemia inhibits neuromuscular and [[Muscle: Cardiac|myocardial]] depolarization leading to muscle weakness and [[Heart Arrhythmias|arrhythmias]].<ref name=":0" /> | ||
== Diagnosis == | |||
| | Hypercalcemia is diagnosed by [[Blood Tests|blood tests]] revealing increased serum calcium levels. However, other tests may need to be done in order to determine the underlying cause of hypercalcemia. These may include: Chest X-Ray; CT Scan; MRI; Mammogram | ||
< | These tests may help determine whether client has lung cancer, breast cancer, other malignancies, or [[sarcoidosis]] (a granulomatous disease of the lungs). <ref name="p3">Hypercalcemia [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=causes</ref> | ||
== Treatment == | |||
The treatment of hypercalcemia varies depending upon how elevated the calcium is, as well as the cause. Medical approaches used to decrease blood calcium level include medications and interventions. | |||
| | All clinicians and nurses should educate the patients on maintaining hydration, changes in diet and limiting calcium intake. The patient and family should be told about the symptoms of hypercalcemia and when to seek assistance. Physical therapy should be involved to ensure that the patient remains mobile and active (see below). If the patient has a metastatic disease associated with hypercalcemia, the hospice, [[Palliative Care Competence Framework for Physiotherapists|palliative]] care, and [[Pain Assessment|pain]] teams should be involved to ensure that the [[Quality of Life|quality of life]] is not compromised. | ||
A dietitian should be consulted to educate the patient on what type of foods to avoid. With such a team approach, it is hoped that the patient outcomes will improve. | |||
Medications used to treat hypercalcemia include: | |||
* Bisphosphonates, which decrease bone breakdown | |||
* Calcitonin, a medication that can lower elevated calcium levels | |||
* Gallium nitrate, used to treat cancer-related hypercalcemia | |||
* Sensipar (cinacalcet), which lowers calcium in the blood | |||
* [[Corticosteroid Medication|Steroids]]: These drugs may be used in some situations, although steroids can also lower calcium in some instances. The cause of the hypercalcemia will dictate whether steroids are advised or not. | |||
If hypercalcemia is very severe, dialysis may be needed.<ref>Very well health Hypercalcemia Available:https://www.verywellhealth.com/hypercalcemia-in-cancer-patients-2249011 ( accessed 2.4.2022)</ref> | |||
== Physical Therapy Management == | |||
* | *Weight bearing exercises to prevent [[osteoporosis]] and immobility | ||
*Prevention of [[Insufficiency Fracture|fracture]]<nowiki/>s | |||
* | |||
*Ensure adequate hydration | *Ensure adequate hydration | ||
*Quality of life measures | *Quality of life measures | ||
*Strength/ROM | *[[Strength Training|Strength]]/ROM | ||
*Patient and Family Education | *Patient and Family Education<ref name="p2">Hypercalcemia in Emergency Medicine [Internet]. Medscape. 2010 [updated 2010 Sep 1]. Available from:fckLRfckLRhttp://emedicine.medscape.com/article/766373-overview#a0199</ref> | ||
<ref name=" | |||
== Prognosis == | |||
The prognosis of patients with hypercalcemia depends upon the etiology of the elevation:<ref name="p2" /> | |||
The prognosis of patients with hypercalcemia depends upon the etiology of the elevation:<ref name=" | |||
*Prognosis is very poor with malignancy that has progressed into development of hypercalcemia. | *Prognosis is very poor with malignancy that has progressed into development of hypercalcemia. | ||
*Prognosis is excellent when the underlying cause is treatable and treatment is initiated promptly. | *Prognosis is excellent when the underlying cause is treatable and treatment is initiated promptly. | ||
== References<br> == | == References<br> == | ||
<references /> | <references /> | ||
<br> | <br> | ||
<br> | <br> |
Latest revision as of 23:52, 2 April 2022
Original Editors - Whitney Browning & Natalie Elliott from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Whitney Browning, Natalie Elliott, Elaine Lonnemann, Admin, Lucinda hampton, 127.0.0.1, WikiSysop and Kim Jackson
Introduction[edit | edit source]
Hypercalcemia is a condition in which the calcium level in the blood is above normal. Too much calcium in your blood can weaken the bones, create kidney stones, and interfere with how the heart and brain work.
Hypercalcemia is usually a result of overactive parathyroid glands. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements[1].
- Signs and symptoms of hypercalcemia range from nonexistent to severe. Treatment depends on the cause.
- Normal calcium levels range from 8.2-10.2 mg/dL. Mild hypercalcemia occurs when this level raises to 12mg/dL and severe hypercalcemia is classified as serum calcium at 14mg/dL.[2]
Epidemiolgy[edit | edit source]
The prevalence of hypercalcemia in the general population is approximately 1% to 2%. Most of the cases (90%) of hypercalcemia are due to primary hyperparathyroidism and malignancy-associated hypercalcemia[3].
Etiology[edit | edit source]
Common causes of hypercalcemia include: [4]
- Overactivity of parathyroid glands
- Cancer-specifically lung and breast cancer as well as multiple myeloma can increase the risk of hypercalcemia. This is considered to be due to the fact that some malignant tumors can produce a protein that acts similar to the parathyroid hormone which stimulates the release of calcium from the bones into the bloodstream.
- Other disease effects-some people with cancer that causes them to spend increased time lying down or in bed may cause bones to release calcium into the blood due to the lack of weight-bearing.
- Medications-Lithium, a drug used to treat bipolar disorder, may increase the release of parathyroid hormone and cause hypercalcemia. Also, Thiazie diuretics can cause elevated calcium levels by decreasing the amount of calcium excreted in the urine.
- Supplements-eating or drinking too much calcium or Vitamin D
- Dehydration-less fluid in your blood causes the calcium levels to increase
Characteristics/Clinical Presentation[edit | edit source]
Many of the symptoms of hypercalcemia are ones that are characteristic of other conditions. More-severe cases produce signs and symptoms related to the parts of the body affected by the high calcium levels in the blood. Examples include:
- Gastrointestinal symptoms like pain, nausea, and vomiting. Hypercalcemia can lead to peptic ulcer disease and pancreatitis.
- Bone related complications like bone pain. Hypercalcemia can lead to osteoporosis, osteomalacia, arthritis and pathological fractures.
- Renal stones causing pain.
- Fatigue and malaise.
- Polyuria, polydipsia, and constipation.
- Lethargy, confusion, depression and memory loss.
Severe hypercalcemia inhibits neuromuscular and myocardial depolarization leading to muscle weakness and arrhythmias.[3]
Diagnosis[edit | edit source]
Hypercalcemia is diagnosed by blood tests revealing increased serum calcium levels. However, other tests may need to be done in order to determine the underlying cause of hypercalcemia. These may include: Chest X-Ray; CT Scan; MRI; Mammogram
These tests may help determine whether client has lung cancer, breast cancer, other malignancies, or sarcoidosis (a granulomatous disease of the lungs). [5]
Treatment[edit | edit source]
The treatment of hypercalcemia varies depending upon how elevated the calcium is, as well as the cause. Medical approaches used to decrease blood calcium level include medications and interventions.
All clinicians and nurses should educate the patients on maintaining hydration, changes in diet and limiting calcium intake. The patient and family should be told about the symptoms of hypercalcemia and when to seek assistance. Physical therapy should be involved to ensure that the patient remains mobile and active (see below). If the patient has a metastatic disease associated with hypercalcemia, the hospice, palliative care, and pain teams should be involved to ensure that the quality of life is not compromised.
A dietitian should be consulted to educate the patient on what type of foods to avoid. With such a team approach, it is hoped that the patient outcomes will improve.
Medications used to treat hypercalcemia include:
- Bisphosphonates, which decrease bone breakdown
- Calcitonin, a medication that can lower elevated calcium levels
- Gallium nitrate, used to treat cancer-related hypercalcemia
- Sensipar (cinacalcet), which lowers calcium in the blood
- Steroids: These drugs may be used in some situations, although steroids can also lower calcium in some instances. The cause of the hypercalcemia will dictate whether steroids are advised or not.
If hypercalcemia is very severe, dialysis may be needed.[6]
Physical Therapy Management[edit | edit source]
- Weight bearing exercises to prevent osteoporosis and immobility
- Prevention of fractures
- Ensure adequate hydration
- Quality of life measures
- Strength/ROM
- Patient and Family Education[7]
Prognosis[edit | edit source]
The prognosis of patients with hypercalcemia depends upon the etiology of the elevation:[7]
- Prognosis is very poor with malignancy that has progressed into development of hypercalcemia.
- Prognosis is excellent when the underlying cause is treatable and treatment is initiated promptly.
References
[edit | edit source]
- ↑ Mayo clinic Hypercalcemia Available: https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523(accessed 2.4.2022)
- ↑ Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, MO: Elsevier Saunders; 2013.
- ↑ 3.0 3.1 Sadiq NM, Naganathan S, Badireddy M. Hypercalcemia.[Updated August 11, 2021]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021. Available;https://www.ncbi.nlm.nih.gov/books/NBK430714/ (accessed 2.4.2022)
- ↑ Hypercalcemia: Causes [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=treatments%2Dand%2Ddrugs
- ↑ Hypercalcemia [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=causes
- ↑ Very well health Hypercalcemia Available:https://www.verywellhealth.com/hypercalcemia-in-cancer-patients-2249011 ( accessed 2.4.2022)
- ↑ 7.0 7.1 Hypercalcemia in Emergency Medicine [Internet]. Medscape. 2010 [updated 2010 Sep 1]. Available from:fckLRfckLRhttp://emedicine.medscape.com/article/766373-overview#a0199