Hypercalcaemia (in US English Hypercalcemia) is an elevated calcium level in the blood. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Calcium (Ca2+ plays a vital role in the Anatomy, Physiology and Biochemistry of Organisms and of the cell, particularly Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products (Normal range: 9-10. 5 mg/dL or 2. 2-2. 6 mmol/L). It can be an asymptomatic laboratory finding, but because an elevated calcium level is often indicative of other diseases, a diagnosis should be undertaken if it persists. It can be due to excessive skeletal calcium release, increased intestinal calcium absorption, or decreased renal calcium excretion.
Signs and symptoms
Hypercalcemia per se can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis or increased urination "Bones, stones, groans, and psychic moans" is a saying which will help you remember the signs and symptoms of hypercalcemia; if it is chronic it can result in urinary calculi (renal stones or bladder stones). Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Confusion, of a Pathological degree usually refers to loss of orientation (ability to place oneself correctly in the world by time location and personal identity and Anorexia (deriving from the Greek "α(ν-" ( a(n-, a prefix that denotes absence + "όρεξη (orexe = appetite is the decreased sensation Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form Abnormal heart rhythms can result, and EKG findings of a short QT interval and a widened T wave suggest hypercalcemia. Dysrhythmia redirects here For the American band see Dysrhythmia (band. In medicine specifically Cardiology, the QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the heart's
Symptoms are more common at high calcium blood values (12. A Reference range is a set of values used by a Health professional to interpret a set of Medical test results 0 mg/dL or 3 mmol/l). Severe hypercalcemia (above 15-16 mg/dL or 3. 75-4 mmol/l) is considered a medical emergency: at these levels, coma and cardiac arrest can result. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness. A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of
Causes
- hyperparathyroidism and malignancy account for ~90% of cases
- abnormal parathyroid gland function
- malignancy
- solid tumor with metastasis (e. The parathyroid glands are small endocrine Glands in the neck usually located behind the Thyroid gland, which produce Parathyroid hormone. Primary hyperparathyroidism causes Hypercalcemia (elevated blood calcium levels through the excessive secretion of Parathyroid hormone (PTH usually by an Adenoma An adenoma is a collection of growths (-oma of glandular origin Hyperplasia (or "hypergenesis" is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen in e A carcinoma is any Malignant Cancer that arises from epithelial cells. The term multiple endocrine Neoplasia ( MEN) encompasses several distinct Syndromes featuring tumors of endocrine glands each with its own characteristic The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them Lithium (ˈlɪθiəm is a Chemical element with the symbol Li and Atomic number 3 The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them g. breast cancer)
- solid tumor with humoral mediation of hypercalcemia (e. Breast cancer is a Cancer that starts in the cells of the Breast in women and men g. lung or kidney cancer, pheochromocytoma)
- hematologic malignancy (multiple myeloma, lymphoma, leukemia)
- vitamin-D metabolic disorders
- hypervitaminosis D (vitamin D intoxication)
- elevated 1,25(OH)2D (see calcitriol under Vitamin D) levels (e. Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung. "Kidney Cancer" redirects here For Wilms' Tumor/Nephroblastoma see Wilms' tumor. A phaeochromocytoma ( pheochromocytoma in the US is a Neuroendocrine tumor of the medulla of the Adrenal glands (originating in the Chromaffin Hematology ( American English) or haematology ( British English) is the branch of biology (physiology Pathology, Clinical laboratory Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of Lymphoma a type of Neoplasm that originates in Lymphocytes (a type of White blood cell in the vertebrate Immune system) Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or Inborn errors of metabolism comprise a large class of genetic Diseases involving disorders of Metabolism. Hypervitaminosis D is a state of Vitamin D toxicity The recommended daily allowance is 400 IU per day Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or g. sarcoidosis and other granulomatous diseases)
- idiopathic hypercalcemia of infancy (Online 'Mendelian Inheritance in Man' (OMIM) 143880)
- rebound hypercalcemia after rhabdomyolysis
- disorders related to high bone-turnover rates
- renal failure
Treatments
The goal of therapy is to treat the hypercalcemia first and subsequently effort is directed to treat the underlying cause. Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them Rhabdomyolysis is the rapid breakdown ( Lysis) of Skeletal muscle tissue ( rhabdomyo) due to injury to muscle tissue Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine Thiazide is a term used to describe a type of molecule and a class of Diuretic. Vitamin A refers to a family of similarly shaped molecules the Retinoids. Paget's disease, otherwise known as osteitis deformans, is a chronic disorder that typically results in enlarged and deformed bones Renal failure or kidney Secondary hyperparathyroidism refers to the excessive secretion of Parathyroid hormone (PTH by the Parathyroid glands in response to Hypocalcemia (low WikipediaNaming In Medicine, milk-alkali syndrome, also called Burnett's syndrome in honour of the American physician who first described it is characterized by Hypercalcemia caused
Initial therapy: fluids and diuretics
- hydration, increasing salt intake, and forced diuresis. Forced diuresis (increased Urine formation by Diuretics and fluid may enhance the excretion of certain drugs in urine and is used to treat Drug overdose
- hydration is needed because many patients are dehydrated due to vomiting or renal defects in concentrating urine.
- increased salt intake also can increase body fluid volume as well as increasing urine sodium excretion, which further increases urinary calcium excretion (In other words, calcium and sodium (salt) are handled in a similar way by the kidney. Anything that causes increased sodium (salt) excretion by the kidney will, en passant, cause increased calcium excretion by the kidney)
- after rehydration, a loop diuretic such as furosemide can be given to permit continued large volume intravenous salt and water replacement while minimizing the risk of blood volume overload and pulmonary edema. Loop diuretics are Diuretics that act on the ascending Loop of Henle in the Kidney. Furosemide ( INN) or frusemide (former BAN) is a Loop diuretic used in the treatment of congestive Heart failure and Edema Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause In addition, loop diuretics tend to depress renal calcium reabsorption thereby helping to lower blood calcium levels
- can usually decrease serum calcium by 1-3 mg/dL within 24 h
- caution must be taken to prevent potassium or magnesium depletion
Additional therapy: bisphosphonates and calcitonin
- bisphosphonates are pyrophosphate analogues with high affinity for bone, especially areas of high bone-turnover. Loop diuretics are Diuretics that act on the ascending Loop of Henle in the Kidney. In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone In Chemistry, the Anion, the Salts and the Esters of Pyrophosphoric acid are called pyrophosphates.
- they are taken up by osteoclasts and inhibit osteoclastic bone resorption
- current available drugs include (in order of potency): (1st gen) etidronate, (2nd gen) tiludronate, IV pamidronate, alendronate, risedronate, and (3rd gen) zoledronate
- all patients with cancer-associated hypercalcemia should receive treatment with bisphosphonates since the 'first line' therapy (above) cannot be continued indefinitely nor is it without risk. An osteoclast (from the Greek words for "bone" and "broken" is a type of Bone cell that removes Bone tissue by removing its Mineralized matrix Etidronic acid ( INN) or etidronate disodium (trade name Didronel) is a Bisphosphonate used to strengthen Bone, treat Osteoporosis Tiludronic acid ( INN; also known as tiludronate is a Bisphosphonate. Pamidronic acid ( INN) or pamidronate disodium ( USAN) pamidronate disodium pentahydrate is a nitrogen containing Bisphosphonate, used In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone Further, even if the 'first line' therapy has been effective, it is a virtual certainty that the hypercalcemia will recur in the patient with hypercalcemia of malignancy. Use of bisphoponates in such circumstances, then, becomes both therapeutic and preventative
- patients in renal failure and hypercalcemia should have a risk-benefit analysis before being given bisphosphonates, since they are relatively contraindicated in renal failure. Renal failure or kidney Hypercalcaemia (in American English '''Hypercalcemia''' is an elevated calcium level in the Blood. In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone Renal failure or kidney
- Calcitonin blocks bone resorption and also increases urinary calcium excretion by inhibiting renal calcium reabsorption
- Usually used in life-threatening hypercalcemia along with rehydration, diuresis, and bisphosphonates
- Helps prevent recurrence of hypercalcemia
- Dose is 4 Units per kg via subcutaneous or intramuscular route every 12 hours, usually not continued indefinitely
Other therapies
- rarely used, or used in special circumstances
- plicamycin inhibits bone resorption (rarely used)
- gallium nitrate inhibits bone resorption and changes structure of bone crystals (rarely used)
- glucocorticoids increase urinary calcium excretion and decrease intestinal calcium absorption
- dialysis usually used in severe hypercalcemia complicated by renal failure. Calcitonin is a 32-amino acid linear polypeptide Hormone that is produced in Humans primarily by the parafollicular (also known as C-cells of the Plicamycin ( INN, also known as mithramycin; trade name Mithracin) is an Antineoplastic Antibiotic produced by Streptomyces Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Hodgkin's lymphoma, also known as Hodgkin's disease is a type of Lymphoma first described by Thomas Hodgkin in 1832 Breast cancer is a Cancer that starts in the cells of the Breast in women and men Hypervitaminosis D is a state of Vitamin D toxicity The recommended daily allowance is 400 IU per day Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Renal failure or kidney Supplemental phosphate should be monitored and added if necessary
- phosphate therapy can correct the hypophosphatemia in the face of hypercalcemia and lower serum calcium
See also
A phosphate, an Inorganic chemical, is a salt of Phosphoric acid. Calcium metabolism or calcium homeostasis is the mechanism by which the body maintains adequate Calcium levels Dent's disease (or Dent disease) is a rare X-linked recessive inherited condition that affects the Kidney. In Medicine, hypocalcaemia is the presence of low serum Calcium levels in the Blood, usually taken as less than 2 Electrolytes play a vital role in maintaining Homeostasis within the body Disorders of calcium metabolism occur when the body has too little or too much Calcium. A section of the Anatomical Therapeutic Chemical Classification System.
Dictionary
hypercalcaemia
-noun
- Alternative spelling of hypercalcemia.
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