Hypercalcemia 

Hypercalcemia is a common but often missed medical condition that occurs when blood calcium levels become too high. Blood calcium levels should stay between 8 and 10 mg/dL. Patients with elevated calcium in their blood show several symptoms, including kidney stones, bone pain, stomach discomfort, depression, weakness, and confusion. This blog explains what patients should know about diagnosis and hypercalcemia treatment options. 

What is Hypercalcemia? 

Blood calcium levels above 8.5-10.5 milligrams per deciliter (mg/dL) indicate hypercalcemia disease. This condition throws off your body's calcium balance, which your parathyroid glands, kidneys, and digestive tract usually manage to keep in check. Doctors classify hypercalcemia based on severity: mild (10.5-11.9 mg/dL), moderate (12.0-13.9 mg/dL), or severe (above 14.0 mg/dL). Your body's normal functions start breaking down when calcium levels stay high; untreated cases can damage organs. 

Hypercalcemia Signs and Symptoms 

You might not notice any symptoms with mild hypercalcemia. As calcium levels climb, symptoms can affect several body systems: 

• Kidney-related: Excessive thirst, frequent urination, kidney stones 
• Digestive system: Nausea, vomiting, poor appetite, constipation, abdominal pain Bones and muscles: Bone pain, muscle weakness, fatigue 
• Brain: Confusion, memory problems, depression, difficulty concentrating Heart: Irregular heartbeat, palpitations, high blood pressure 

Causes of Hypercalcemia 

Overactive parathyroid glands cause about 90% of hypercalcemia cases. These glands release too much parathyroid hormone into your system. Cancer ranks as the second most common cause, especially lung, breast, kidney cancers, and blood cancers like multiple myeloma. 

Other hypercalcemia causes include: 

• Too many vitamin D or calcium supplements 
• Medications (thiazide diuretics, lithium) 
• Granulomatous diseases (tuberculosis, sarcoidosis) 
• Prolonged immobility 
• Severe dehydration 
• Genetic conditions like familial hypocalciuric hypercalcemia

Risks of Hypercalcemia 

Several factors can raise your risk of developing hypercalcemia. These include: 

• Women over 50 face higher risks due to post-menopausal changes. 
• Cancer patients, particularly those with bone metastases, are more vulnerable. 
• People with kidney disease, parathyroid disorders, or those on certain medications might develop this condition. 
• Your lifestyle choices matter too - lack of physical activity and heavy alcohol use can increase your risk. 

Side Effects of Elevated Calcium Levels 

Untreated hypercalcemia can lead to serious health issues. Your kidneys might fail, develop stones, or accumulate calcium deposits. Bone problems often follow, including osteoporosis, fractures, and bone cysts. Severe cases can affect your heart rhythm and brain function, potentially leading to confusion, dementia, or coma. Your digestive system might also suffer complications like pancreatitis and peptic ulcers. 

Diagnosis 

Doctors use several tests to check elevated calcium in blood and figure out what's causing them. 

Blood tests are the first step in checking calcium and parathyroid hormone levels. These tests help doctors learn how different body systems work. 

Urine tests come next to measure calcium excretion and spot kidney problems. 

If the cause isn't clear, doctors might need:  

• Electrocardiogram (EKG) to record heart electrical activity 
• Chest X-ray to check for lung cancer or infections 
• Mammogram to screen for breast cancer 
• CT or MRI scans to look at internal organs 
• DEXA scan to measure bone density 

Hypercalcemia Treatments 

The treatment plan depends on how severe the condition is and what's causing it. Doctors monitor mild cases (calcium <11.5 mg/dL) while they treat the root cause. Moderate cases have several treatment options: 

Medications: 

• Calcitonin - A hormone that quickly lowers calcium levels 
• Bisphosphonates - These work best for cancer-related hypercalcemia 
• Calcimimetics - Helps control overactive parathyroid glands 
• Prednisone - Works well for vitamin D-related hypercalcemia
• Denosumab - Useful when bisphosphonates don't work 

Severe hypercalcemia needs hospital care with IV fluids and diuretics. 

When to See a Doctor 

You should get medical help right away if you notice extreme thirst, frequent urination, abdominal pain, confusion, or irregular heartbeat. Mild hypercalcemia might not cause symptoms, but without treatment, it can lead to serious problems like kidney stones, osteoporosis, and even coma. 

Prevention 

You can take several steps to prevent hypercalcemia. 

• Drinking plenty of water makes your kidneys flush out extra calcium. 
• Don't take calcium supplements unless your doctor prescribes them. 
• Regular weight-bearing exercises improve bone health and keep calcium in your bones instead of your blood. 
• People with underlying conditions should check their calcium levels often and talk to their doctors about management strategies. 

Conclusion 

Hypercalcemia is a serious health issue that affects up to 2% of the population. Mild cases might show no symptoms, but this condition just needs attention due to its potential risks. Primary hyperparathyroidism and cancer are the most common reasons behind high calcium levels, and many other factors can trigger this condition, too. Regular blood tests help detect it early and give the best chance to manage it before permanent damage occurs. Proper medical care helps manage hypercalcemia effectively despite its serious nature. Doctors choose treatment based on how severe the condition is and why it happens. Options range from simple monitoring to medication, surgery, or hospitalisation in severe cases. Without a doubt, patients who understand their condition make better health choices and work better with their doctors 

FAQs 

1. What is the difference between hypocalcemia and hypercalcemia? 

These conditions show opposite calcium imbalances in the blood. Hypocalcemia happens when calcium levels drop below the normal range. Hypercalcemia occurs when calcium levels go above 10.5 mg/dL. Both conditions affect many body systems but create different symptoms. Hypocalcemia usually causes muscle stiffness, spasms, confusion, and memory issues. Hypercalcemia can cause kidney stones, bone pain, & digestive problems. 

2. How common is hypercalcemia? 

Hypercalcemia affects about 1-2% of people worldwide. 

3. Who does hypercalcemia affect? 

People of all ages can get this condition, but women over 50 face the highest risk, especially after menopause. Cancer patients are particularly vulnerable, with about 2% of all cancers linked to hypercalcemia. 

4. How do you lower the calcium levels in your blood? 

You can reduce blood calcium levels through several methods: 

• Drink plenty of water (3-4 litres daily) so your kidneys can flush excess calcium 
• Take prescribed medical treatments like IV fluids, medications such as 
• Bisphosphonates, calcitonin, or corticosteroids 
• Stay active when possible, since lack of movement can make hypercalcemia worse 
• Skip calcium supplements unless your doctor recommends them 

5. What deficiency causes high calcium? 

High calcium rarely results from deficiencies-it's usually caused by excess. Too much vitamin D from supplements can raise calcium levels by increasing absorption from the digestive tract. Some medications, like lithium and thiazide diuretics, might raise calcium levels by affecting the function of the parathyroid. 

6. What foods reduce calcium in the blood? 

Salty foods and alcohol can help lower blood calcium levels. Foods rich in fibre with phytates (found in whole grains, legumes, and nuts) might block calcium absorption when eaten with calcium-rich foods. Foods abundant in oxalic acid (spinach, beet greens, rhubarb, and sweet potatoes) also bind calcium and reduce its absorption. 

7. What not to eat if you have high calcium? 

People with hypercalcemia should limit: 

• Dairy products (milk, cheese, yoghurt, ice cream)
• Calcium-fortified foods (orange juice, cereals)
• Canned fish with soft bones (salmon, sardines)
• Calcium-containing antacids 
• High-salt foods
• Too much alcohol 

8. How do we reduce hypercalcemia naturally? 

Good hydration works best to manage hypercalcemia naturally by helping your body flush excess calcium through urine. Smart meal timing helps - eat calcium-binding foods at least two hours before or after calcium-rich foods. Regular activity helps your body use calcium properly, but staying still too long can make things worse. Cutting back on alcohol stops calcium from leaving your bones.

Dr. Kamal P. Bhutada

MD, DNB (General Medicine), MNAMS, IDCCM, EDIC
Ganga CARE Hospital Limited, Nagpur

To Book an Appointment, call:

+91 40-68106529