Calcium is an essential mineral that is one of the main constituent of the human body. It helps in regulating many bodily functions like bone formation, release of hormones, muscle contraction and nerve and brain function. When the concentration of calcium is above the normal in the human blood it is referred to as Hypercalcemia. Systematic regulation of calcium in the body occurs in the presence of three hormones which are parathyroid hormone (PTH), Vitamin D and calcitonin. These hormones act on the bones, the kidneys and the gastrointestinal tract. Hypercalcemia results from malignancy or primary hyperparathyroidism. It may also occur due to excess intake of vitamin D or vitamin A, adrenal gland insufficiency, cancer like multiple myeloma, kidney failure and other diseases like thiazide-diuretics, sarcoidosis and Paget’s disease of the bones.
Symptoms of Hypercalcemia:
- Constipation
- Nausea
- Abdominal pain
- Poor appetite
- Vomiting
- Flank pain
- Excessive thirst
- Frequent urination
- Kidney stones
- Muscle atrophy
- Muscle twitches
- Weakness
- Apathy
- Coma
- Dementia
- Depression
- Irritability
- Memory Loss
- Bone ache
- Bowing of the shoulders
- Pathological fractures
- Loss of height
- Spinal column curvature
Diagnosis of Hypercalcemia:
A blood test is the primary test undertaken for the detection of hypercalcemia. An electrocardiogram is also done to diagnose this disease. Diagnosing the causes of the disease is, however, a more complicated process. It involves the analysis of the detailed medical history of the patient and physical examination. It may require further blood tests like that for PTH level and vitamin D level. Also is undertaken urine evaluation, X-rays and other imaging processes.
Hypercalcemia Treatment:
The treatment of this calcium disorder depends on the level, the chronicity and the underlying cause of the problem. The fundamental goal of the treatment should be to stabilize and reduce the calcium levels, to check for adequate hydration, to increase urinary calcium excretion, to inhibit osteoclast activity in the bone, to discontinue pharmacological agents related to this condition and to treat the root cause of the disease, if possible.
In patients with extreme levels of elevated calcium they must first be hydrated with saline. Hydration reduces the calcium level by means of dilution. The increase in the extracellular volume also aids in the increase of renal calcium clearance. The consequent fluid therapy is given to the patients according to the degree of hypercalcemia, severity of dehydration and ability of the patient to tolerate the rehydration. However, hydration is of least use in patients with kidney failure because diuresis is not possible. In patients with renal failure dialysis is introduced for the process of hydration.
A loop diuretic when used with hydration to increase calcium excretion. Thiazide diuretics is to be avoided since it helps in the reabsorption of calcium. Biophosphates is also used in the treatment of hypercalcemia. They help in the inhibition of osteoclast activity for up to a month. Biophosphates mode of action is by binding to hydroxyapatite in the bone matrix thereby stopping the crystals from dissolving. These agents interfere with osteoclast recruitment and viability and prevent osteoclast attachment to the bone matrix.
