Hypercalcemia

Group Members:Joshua GriffithJennifer Haynes

What is Hypercalcemia?

Hypercalcemia is too much calcium in the blood

> 10mg/dl of Ca+ in the blood.

Calcium is important to many body functions, including:

•Bone formation•Hormone release•Muscle contraction•Nerve and brain function

Physiology

Parathyroid hormone (PTH) and Vitamin D help manage calcium balance in the body.

PTH is made by the parathyroid glands, which are four small glands located in the neck behind the thyroid gland.

Vitamin D is obtained when the skin is exposed to sunlight, and from dietary sources such as:egg yolks, fish

Etiology of Hypercalcemia

Primary hyperparathyroidism is the most common cause of hypercalcemia.

It is due to excess PTH release by the parathyroid glands.

This excess occurs due to an enlargement of one or more of the parathyroid glands, or a growth on one of the glands. (Most of the time, these growths are not cancerous).

Etiology cont'd Other conditions can also cause

hypercalcemia:

An inherited condition that affects the body's ability to regulate calcium (familial hypocalciuric hypercalcemia)

Being bed-bound (or not being able to move) for a long period of time (this occurs most often in young people)

Etiology cont'd Calcium excess in the diet. This is

called milk-alkali syndrome. It is most often due to at least 2,000 milligrams of calcium per day. Taking too much vitamin D may add to the problem.

Hyperthyroidism Kidney failure Medications such as lithium and

thiazide diuretics (water pills)

Etiology cont'd

Some cancerous tumors (for example, lung cancers, breast cancer)

Some infectious and inflammatory diseases such as tuberculosis, Paget's disease and sarcoidosis

Risk Factors of hypercalcemia

Women over age 50 (after menopause) are most likely to have hypercalcemia. In most cases, this is due to primary hyperparathyroidism.

Hypercalcemia affects fewer than 1 in 100 people.

Prevalence of hypercalcemia

Clinical Manifestation of Hypercalcemia

Abdominal symptoms: Constipation Nausea Pain Poor appetite/ loss of apetite Vomiting Weight loss- Anarexia Increaased thirst

Cont'd of Clinical Manifestation

Kidney symptoms: Flank pain Frequent thirst Frequent urination- full of excreted

calcium- renal caclil (Kidney stones) Confuesed to bizzare behavior- Heart Contractilitly deacresaed- heart

block and cardiac arrest Muscles are weak- at great risk of falls

Cont'd CM

Muscle symptoms: Muscle twitches Weakness Psychological symptoms: Apathy Dementia Depression Irritability

Cont'd CM

Memory loss Skeletal symptoms: Bone pain Bowing of the shoulders Fractures due to disease (pathological

fractures) Loss of height Spinal column curvature

Treatment Actions

Restrict Ca+ intake Loup Diuretics(Lasix)- excretion of

calcium Maintain Safe Environment Weight bearing exercises

Treatment

Treatment is aimed at the cause of hypercalcemia whenever possible.

Primary hypercalcemia - surgery Mild - monitor over time Severe hypercalcemia that causes

symptoms: Calcitonin Dialysis Diuretic medication, such as furosemide

Cont'd treatment

Drugs that stop bone breakdown and absorption by the body, such as pamidronate or etidronate (bisphosphonates)

Fluids through a vein (intravenous fluids) - this is the most important therapy

Glucocorticoids (steroids)

Complications of hypercalcemia

Osteoporosis Kidney stones Kidney failure Nervous system problems Abnormal heart rhythm (arrhythmia)

References Bringhurst R, Demay MB, Kronenberg HM.

Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology

22/9/2015 Wysolmerski JJ, Insogna KL. The parathyroid

glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds.Cecil Medicine

22/9/2015 https://

www.youtube.com/watch?v=LIdAVjWwIFo

22/9/2015