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Hypercalcemia

Hypercalcaemia (or Hypercalcemia) is an elevated calcium level in the blood. It can be an asymptomatic laboratory finding, but because an elevated calcium level is often a clue to other serious disease, a diagnosis should be undertaken if it persists. more...

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Signs and symptoms

Hypercalcemia per se can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, or increased urination; if it is chronic it can result in urinary calculi (renal stones or bladder stones). Abnormal heart rhythms can result, and an EKG finding of a short QT interval suggests hypercalcemia.

Symptoms are more common at high calcium levels (12.0 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.

Causes

  • abnormal parathyroid gland function
    • primary hyperparathyroidism
      • solitary parathyroid adenoma
      • primary parathyroid hyperplasia
      • parathyroid carcinoma (C750)
      • multiple endocrine neoplasia (MEN)
      • familial isolated hyperparathyroidism (OMIM 146200)
    • lithium use
    • familial hypocalciuric hypercalcemia/familial benign hypercalcaemia (OMIM 145980, OMIM 145981, OMIM 600740)
  • malignancy
    • solid tumor with metastasis (e.g. breast cancer)
    • solid tumor with humoral mediation of hypercalcemia (e.g. lung or kidney cancer)
    • hematologic malignancy (multiple myeloma, lymphoma, leukemia)
  • vitamin-D metabolic disorders
    • hypervitaminosis D (vitamin D intoxication)
    • elevated 1,25(OH)2D levels (e.g. sarcoidosis and other granulomatous diseases)
    • idiopathic hypercalcemia of infancy (OMIM 143880)
    • rebound hypercalcemia after rhabdomyolysis
  • disorders related to high bone-turnover rates
    • hyperthyroidism
    • prolonged immobilization
    • thiazide use
    • vitamin A intoxication
  • renal failure
    • severe secondary hyperparathyroidism
    • aluminum intoxication
    • milk-alkali syndrome

Treatments

Definitive treatment is directed at the underlying cause. Emergency treatment consists of intravenous hydration, increased salt intake, use of diuretics, and in extreme cases such drugs as bisphosphonates or calcitonin.

Read more at Wikipedia.org


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Incidence and risk factors for hypercalcemia in intensive care unit
From CHEST, 10/1/05 by Nathalie Gagnon

PURPOSE: Immobilisation may be associated with excessive bone resorption leading to hyperealcemia and its complications such as delirium, renal failure and bowel dysfunction. Incidence, risk factors as well as clinical consequences of immobilisation-associated hyperealcemia are not known for patients with extended intensive care unit (ICU) stay. This retrospective cohort study was designed to evaluate the incidence as well as the risk factors of hypercalcemia for adult patients with extended (more than 28 days) ICU stay.

METHODS: All medical records of adult patients with an ICU stay of more than 28 days from 2002 to 2005 were reviewed. For each patient, the highest ionized calcemia was noted as well as the following informations: age, gender, race, weight, admission diagnosis, date of highest ionized calcemia with its associated creatinine level, diagnosis of septic shock, diagnosis of acute respiratory distress syndrome (ARDS), continuous veno-venous hemofiltration (CVVH), mechanical ventilation, parenteral nutrition, and corticotherapy.

RESULTS: Seventy-nine patients stayed in ICU for more than 28 days. Mean age was 53 [+ or -] 18 year-old. Twelve patients (15%) died. 59 patients (75%) had mechanical ventilation, 13 (16%) had CVVH, 29 (37%) had ARDS. Sixteen patients (20%) had hypercalcemia with a mean ionized calcemia of 1,44 [+ or -] 0,13 mmol/L (normal 1,15-1,29 mmol/L). Twelve of these patients were under CVVH.

CONCLUSION: Hypercalcemia is frequent in patients with extended ICU stay. CVVH seems to be strongly associated with hypercalcemia. For those patients under CVVH, hypercalcemia may be explained by the high calcium concentration in our reinjection solutions (1,75 mmol/L). A prospective study is needed to determine the real incidence of immobilisation-associated hypercalcemia in patients without CVVH.

CLINICAL IMPLICATIONS: Clinicians may considered looking at ionized calcemia in patients with extended ICU stay.

DISCLOSURE: Nathalie Gagnon, None.

Nathalie Gagnon MD * Francois Lauzier MD Francois J. LeBlanc MD Laval University, Quebec, PQ, Canada

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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