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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
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'''Original Editors '''- Whitney Browning &amp; Natalie Elliott [[Pathophysiology of Complex Patient Problems|from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  
'''Original Editors '''- Whitney Browning &amp; Natalie Elliott [[Pathophysiology of Complex Patient Problems|from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  


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== Definition/Description<br> ==
== 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 characterized by elevated calcium levels in the blood. It may include symptoms associated with the musculoskeletal, neurological, cardiovascular, and gastrointestinal<sup></sup><sup></sup><sup></sup>&nbsp;systems. Hypercalcemia is often a sign or symptom of other disease occurring within the body. Normal calcium levels range from 8.2-10.2 mg/dL. Mild hypercalcemia occurs when this level raises to 12mg/dL and severe hypercalcemia&nbsp;is classified as serum calcium at 14mg/dL.<ref name="1">Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, MO: Elsevier Saunders; 2013.</ref>  
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>.


== Prevalence  ==
* 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&nbsp;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>


Hypercalcemia is a rather common medical emergency. Between 20-40% of patients suffering from cancer develp this during the course of their disease. It is considered the most common serious electrolyte presenting in adults with malignancies. This disorder often occurs in cases of metastatic bone disease with osteolytic lesion, breast cancer and myeloma. This is related to an increase in bone resorption caused by tumor cell production of parathyroid hormone-related protein that stimulates osteoclasts. It is also associated with primary hyperparathyroidism which occurs in 25 per 100,000 individuals and 75 per 100,000 hospitalized patients. This condition is the most common cause of mild hypercalcemia and can be treated through outpatient care. More than 50,000 cases occur in the U.S. each year<span style="font-size: 11px;">.&nbsp;<ref name="2">Hypercalcemia in Emergency Medicine [Internet]. Medscape. 2010 [updated 2010 Sep 1]. Available from:
== Epidemiolgy ==


http://emedicine.medscape.com/article/766373-overview#a0199</ref></span><br>
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>.


== Characteristics/Clinical Presentation<br> ==
== Etiology ==
Common causes of hypercalcemia include:&nbsp;<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>  


<br>
*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.&nbsp;
{| width="90%" border="1" cellpadding="1" cellspacing="1"
*Other disease&nbsp;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.&nbsp;
| '''&nbsp; &nbsp; &nbsp;System'''
*Supplements-eating or drinking too much calcium or Vitamin D
| &nbsp; &nbsp; &nbsp;'''Signs/symptoms''' &nbsp; &nbsp; &nbsp;
*[[Dehydration]]-less fluid in your blood causes the calcium levels to increase
|-
| align="left" width="5%" |
'''Musculoskeletal'''&nbsp;  
 
| width="30" |
*&nbsp;Muscle pain, tenderness, and weakness
*Muscle spasms
*Bone pain (worse at night and with weightbearing)
*Pathological fracture
 
<br>
 
|-
| '''Central Nervous System'''
|
*Drowsiness, lethargy, coma
*Irritability, personality changes<br>  
*Confusion
*Headaches
*Depression, memory loss, difficulty concentrating
*Visual disturbances
*Balance/coordination problems
*Changes in deep tendon reflexes (hypo/hyperreflexia)
*Change in muscle tone ( in individuals with pre-existing neurological condition)
*Positive Babinski and/or clonus reflex
*Changes in bowel/bladder function
 
|-
|
'''Gastrointenstinal&nbsp;'''
 
<br>
 
|
*Anorexia (loss of appetite)
*Nausea/vomiting
*Constipation
*Dehydration
*Excessive thirst
 
|-
| '''Cardiovascular'''
|
*Hypertension
*Arrythmia
*Cardiac arrest
 
|}
 
<ref name="1" /><br>
 
== Associated Co-morbidities  ==
 
Hypercalcemia can lead to many other complications such as:<ref name="3">Hypercalcemia [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:
 
http://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=causes</ref><br>


*'''Osteoporosis''': if the bones continue to release calcium into the blood, it could lead to this disease.&nbsp;
== Characteristics/Clinical Presentation ==
*'''Kidney stones''': this could be caused by too much calcium accumulation in the urine, leading to crystal formation in the kidneys.
*'''Kidney failure''': Severe hypercalcemia can lead to damage in the kidneys and possibly cause permanent loss of kidney function.
*'''Nervous system deficits''': Severe hypercalcemia can lead to dementia and confusion.
*'''Arrythmias''': Hypercalcemia can affect the electrical impulses of cardiac muscle, causing irregular heartbeats.
*'''Primary Hyperparathyroidism''': This is often associated with hypercalcemia because it causes an increased release of parathyroid hormone (PTH) which raises serum calcium levels.


<br>
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:


== Medications  ==
* 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.


{| width="90%" border="1" cellpadding="1" cellspacing="1"
Severe hypercalcemia inhibits neuromuscular and [[Muscle: Cardiac|myocardial]] depolarization leading to muscle weakness and [[Heart Arrhythmias|arrhythmias]].<ref name=":0" />
|-
| Medication<ref name="4">Hypercalcemia Treatments and Drugs [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:


http://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=treatments%2Dand%2Ddrugs</ref>
== Diagnosis ==
| Treatment Effect
| Side Effects
|-
| Loop Diuretics (ex; furosemide)
| Flushes out excess calcium from system
| Frequent urination, arrythmias, electrolyte imbalances, dizziness, muscle cramps/weakness, extreme fatigue, blurred vision, confusion, headache, dehydration, fever, sore throat, cough, skin rash, loss of appetite, nausea, vomiting<ref name="6">Diuretics and High Blood Pressure: Uses, Side Effects, and More [Internet]. WebMD. 2013. Available from:fckLRfckLRhttp://www.webmd.com/hypertension-high-blood-pressure/guide/diuretic-treatment</ref>
|-
| Intravenous Biphosphonates
| Prevent bone breakdown, reduce bone pain, reduce the number of pathologic fractures
| Heartburn, headache, constipation, diarrhea, muscle and joint pain<ref name="7">Biphosphonates Uses, Side Effects, Types, Effectiveness [Internet]. WebMD. 2013. Available from:fckLRfckLRhttp://www.webmd.com/osteoporosis/bisphosphonates-for-osteoporosis</ref>
|-
| Calcitonin
| Reduce bone reabsorption and slow bone loss
| Warmth/redness of the skin, itching of the skin, nausea, loss of appetite, stomach pain, vomiting, skin rash, increased urination, eye pain, swelling in the feet, swelling or irritation at injection site (if injection was given)<ref name="8">Calcitonin Side Effects [Internet]. Drugs.com. 2013. Available from:fckLRfckLRhttp://www.drugs.com/sfx/calcitonin-side-effects.html</ref>
|-
| Glucocorticoids
| Help to counter the effect of excess Vitamin D
| Elevated pressure in the eyes, fluid retention that may cause swelling in the legs, increased blood pressure, mood swings, weight gain<ref name="9">Prednisone and other corticosteroids: Balance the risks and benefits [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRwww.mayoclinic.com/health/steroids/HQ01431</ref>
|-
| Hemodialysis
| Remove excess waste and calcium from the bloodstream
| Hypotension, muscle cramps, itching, difficulty sleeping, anemia, pericarditis, hyperkalemia, infection, depression<ref name="10">Hemodialysis: Risks [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hemodialysis/MY00281/DSECTION=risks</ref>
|}


<br>
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:&nbsp;Chest X-Ray; CT Scan; MRI; Mammogram


== Diagnostic Tests/Lab Tests/Lab Values  ==
These tests may help determine whether client has lung cancer, breast cancer, other malignancies, or [[sarcoidosis]] (a granulomatous disease of the lungs).&nbsp;<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.


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:&nbsp;<ref name="3" />
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.


*Chest X-Ray
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.
*CT Scan
*MRI
*Mammogram


These tests may help determine whether you have lung cancer, breast cancer, other malignancies, or sarcoidosis (a granulomatous disease of the lungs).&nbsp;<ref name="3" />[[Image:TH 2011 01 pp13 t01 LG-1.jpg]]
Medications used to treat hypercalcemia include:


http://www.the-hospitalist.org/SpringboardWebApp/userfiles/hosp/image
* 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.


== Etiology/Causes  ==
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>


Common causes of hypercalcemia include:&nbsp;<ref name="5">Hypercalcemia: Causes [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=treatments%2Dand%2Ddrugs</ref>
== Physical Therapy Management ==


*'''Overactivity''' of parathyroid glands
*Weight bearing exercises to prevent [[osteoporosis]] and immobility
*'''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 simlar to the parathyroid hormone which stimulates the release of calcium from the bones into the bloodstream.&nbsp;
*Prevention of [[Insufficiency Fracture|fracture]]<nowiki/>s&nbsp;
*'''Other disease'''&nbsp;'''effects-'''some people with cancer that causes them to spend increased time laying down or in bed may cause bones to release calcium into the blood due to the lack of weightbearing.
*'''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.&nbsp;
*'''Supplements'''-eating or drinking too much calcium or Vitamin D
*'''Dehydration'''-less fluid in your blood causes the calcium levels to increase
 
== Systemic Involvement  ==
 
As stated in the chart above, hypercalcemia can present with symptoms in mutliple systems. Usually, the first signs and symptoms are noticed in the musculoskeletal system causing muscle pain, spasms, or bone pain. However, each patient will present differently depending on the severity and organ system involved.&nbsp;<ref name="1" />
 
== Medical Management (current best evidence)  ==
 
'''Mild Hypercalcemia '''(defined as corrected total serum calcium level lower than 12 mg/dL (&lt;6 mEq/L or 3.0 mmol/L)<ref name="12">Hypercalcemia(PDQ)[Internet]. National Cancer Institute.[updated 2013 Jan 9]Available from: fckLRfckLRhttp://www.cancer.gov/cancertopics/pdq/supportivecare/hypercalcemia/HealthProfessional/page1/AllPages</ref>
 
*Hydration (IV fluids) followed by observation; this option should be considered for asymptomatic patients who are about to be treated for tumors that are likely to respond to antineoplastic treatment (ex: lymphoma, breast cancer, ovarian cancer, head and neck carcinoma, and multiple myeloma).
*Additional interventions should be directed toward controlling nausea and vomiting, encouraging mobility, noting febrile episodes.&nbsp;
*Minimal use of sedating medications.
 
<br> '''Moderate to Severe Hypercalcemia'''&nbsp;(defined as corrected total serum calcium equal to 12 to 14 mg/dL (6–7 mEq/L or 3.0–3.5 mmol/L)<ref name="12" />
 
*Rehydration is the essential first step replenishing extracellular fluid, restoring intravascular volume, and saline diuresis
*Hypocalcemic agents&nbsp;<br>
*Moderate doses of furosemide (20–40 mg every 12 hours) increase saline-induced urinary calcium excretion and are useful in preventing or managing fluid overload in adequately rehydrated patients.&nbsp;
*Surgery; resulting from primary hyperparathyroidism, urgent parathyroidectomey.
 
'''Prevention'''
 
Preventive measures include:<ref name="12" />  
 
*Ensuring adequate fluid intake of 3 to 4 L (100–140 fl oz per day if not contraindicated)
*Salt intake
*Nausea and vomiting control
*Encouraging patient mobility
*Attention to febrile episodes
*Cautious use or elimination of drugs that may complicate management ( ex: drugs that inhibit urinary calcium excretion or decrease renal blood flow, contain calcium, vitamin D, vitamin A, or other retinoids)<br>
 
== Physical Therapy Management (current best evidence)  ==
 
*Weightbearing exercises to prevent osteoporosis and immobility
*Prevention of fractures&nbsp;  
*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="12" />  


== Alternative/Holistic Management (current best evidence)  ==
== Prognosis ==
 
The prognosis of patients with hypercalcemia depends upon the etiology of the elevation:<ref name="p2" />  
*Increase fluid intake
*Substitute with sea salt in diet
*Decease consumption of dietary calcuim and Vitamin D&nbsp;
*Avoid pasteurized dairy products, low-fat dairy products, and processed foods high in polyunsaturated fats and low in saturated fats
*Probiotics
 
<ref name="11">Hypercalcemia, causes, symptoms, remedies [Internet]. Growyouthful.com. 2013. Available from:fckLRfckLRhttp://growyouthful.com/ailment/hypercalcemia-high-calcium.php</ref>
 
== Differential Diagnosis  ==
 
Evaluation of a patient should include: history, physical examination focusing on clinical manifestations of hypercalcemia, risk factors for malignancy, causative medications, and a family history of hypercalcemia-associated conditions to help clincially determine effectively and accurately a differential diagnosis.&nbsp;<ref name="13">A Practical Approach to Hypercalcemia [Internet]. Am Fam Physician. 2003 May 1;67(9):1959-1966. Available from: fckLRfckLRhttp://www.aafp.org/afp/2003/0501/p1959.html</ref>
 
*Hyperparathyroidism
*Malignancy
*Sarcoidosis
*Lithium, Salicylate, Theophylline Toxicity
*Thyroid Toxicity
*Vitamin Toxicity
*Tuberculosis
 
'''Prognosis''':
 
The prognosis of patients with hypercalcemia depends upon the etiology of the elevation:<ref name="2" />  


*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.<br>
*Prognosis is excellent when the underlying cause is treatable and treatment is initiated promptly.
 
== Case Reports/ Case Studies  ==
 
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
 
<br>
 
http://www.aapsus.org/articles/6.pdf
 
== Resources <br>  ==
 
[http://www.cancer.gov/cancertopics/pdq/supportivecare/hypercalcemia/HealthProfessional/page1/AllPages#5 National Cancer Institute]
 
[http://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=causes MayoClinic]
 
[http://www.webmd.com/vitamins-supplements/condition-1270-Hypercalcemia.aspx?diseaseid=1270&diseasename=Hypercalcemia&source=0 WebMD]
 
[http://www.aafp.org/afp/2003/0501/p1959.html American Academy of Family Physicians]
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
<div class="researchbox">
http://www.ncbi.nlm.nih.gov/pubmed/?term=hypercalcemia
</div>
== References<br>  ==
== References<br>  ==


<references />  
<references />  


<br> &nbsp;see [[Adding References|adding references tutorial]].
<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:

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]

  1. ↑ Mayo clinic Hypercalcemia Available: https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523(accessed 2.4.2022)
  2. ↑ Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, MO: Elsevier Saunders; 2013.
  3. ↑ 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)
  4. ↑ Hypercalcemia: Causes [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=treatments%2Dand%2Ddrugs
  5. ↑ Hypercalcemia [Internet]. MayoClinic. 2012 [updated 2012 Aug 10]. Available from:fckLRfckLRhttp://www.mayoclinic.com/health/hypercalcemia/DS00976/DSECTION=causes
  6. ↑ Very well health Hypercalcemia Available:https://www.verywellhealth.com/hypercalcemia-in-cancer-patients-2249011 ( accessed 2.4.2022)
  7. ↑ 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



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