Hypercalcemia. Symptoms

• What is Hypercalcemia
• Symptoms of Hypercalcemia
• Diagnosis of Hypercalcemia
• Treatment of Hypercalcemia
• Which doctors should you contact if you have Hypercalcemia

What is Hypercalcemia

Hypercalcemia - an increase in the concentration of calcium in serum or blood plasma over 2.5 mmol / l. The most common causes of hypercalcemia in adults are malignant neoplasms, mainly of the bronchi and mammary glands, myeloma, hyperparathyroidism and other endocrinopathies (acromegaly, hyperthyroidism), acute renal failure (especially due to rhabdomyolysis), medication (vitamins A and D, thiazides, calcium, lithium) , sarcoidosis, hypophosphatemia, prolonged immobilization, hereditary diseases (familial hypocalyschuric hypercalcemia, subaortic stenosis), etc. In children, hypercalcemia is most often associated with an overdose of vitamin D.

There are many possible causes of hypercalcemia. The incidence of hypercalcemia and the pathophysiological significance of the etiological factors leading to this condition have not yet been sufficiently studied. It is known that hypercalcemia, especially hypercalcemia in hyperparathyroidism, is a fairly common condition that in many patients is either asymptomatic or has blurred symptoms. Fisken et al. reported that they found distinct differences in the incidence and causes of hypercalcemia between the general population and between outpatients and hospital admissions. Based on a review of the literature, the authors concluded that the frequency of hypercalcemia in the general population and among outpatients ranges from 0.1 to 1.6%, and in patients in a therapeutic hospital it ranges from 0.5 to 3.6%. According to several reports, the most common cause of hypercalcemia in the general population and among outpatients is hyperparathyroidism; other researchers report a relatively high incidence of hypercalcemia due to the use of diuretics from the thiazide group, in diseases of the thyroid gland, Burnett's syndrome (milk-alkaline), as well as with prolonged immobilization. Malignant neoplasms are more common among hospital patients than in the general population and are the most common cause of hypercalcemia according to most reports.

Regardless of the category of patients, the assessment and differential diagnosis of hypercalcemia is always carried out on the basis of the results of a clinical examination and a critical assessment of the biochemical study data. Diagnostics should be based on a deep understanding of the mechanisms involved in the regulation of calcium homeostasis in normal conditions, and the nature of violations of these mechanisms in pathological conditions.

What provokes Hypercalcemia

• Primary hyperparathyroidism
• Malignant neoplasms
• Humoral hypercalcemia
• Localized osteolytic hypercalcemia (eg, with myeloma, metastases)
• Hyperthyroidism
• Granulomatous diseases (sarcoidosis)
• Drug hypercalcemia
• Vitamin D overdose
• Milk-alkaline syndrome
• Thiazide diuretics
• Lithium
• Immobilization (Paget's disease)
• Familial hypocalciuric hypercalcemia
• HTLV-1 infection may present with severe hypercalcemia
• Pheochromocytoma (type II multiple endocrine adenomatosis)

Pathogenesis (What Happens?) During Hypercalcemia

Hypercalcemia in malignant neoplasms can be caused by tumor metastases in the bone, enhanced by the production of PGE2 by tumor cells, which causes bone resorption, the action of an osteoclast activating factor secreted by leukocytes, and, finally, parathyroid hormone synthesized by tumor cells. In acute renal failure, hypercalcemia usually develops in the early diuretic phase due to resorption of calcium deposits in soft tissues and increased production of vitamin D metabolite by regenerating renal tissue. Thiazides enhance the reabsorption of calcium in the renal tubules. In sarcoidosis, both an increase in the production of 1,25-dihydroxycholecalciferol and an increase in sensitivity to the action of this metabolite with an increase in calcium absorption in the gastrointestinal tract are found. Prolonged immobilization causes calcium release from the skeleton.

Hypercalcemia causes a spasm of afferent arterioles, reduces renal blood flow (to a greater extent in the cortex than in the medullary), glomerular filtration in an individual nephron and in the kidney as a whole, inhibits reabsorption of sodium, magnesium and potassium in the tubules, increases calcium reabsorption, increases calcium excretion and hydrogen ions. Most of the clinical manifestations of hypercalcemia can be explained by impaired renal function.

Symptoms of Hypercalcemia

Acute hypercalcemia is characterized by weakness, polydipsia, polyuria, nausea, vomiting, increased blood pressure, alternating with the development of dehydration by hypotension and further collapse, lethargy and stupor. In chronic hypercalcemia, neurological symptoms are not so pronounced. Polyuria and, as a consequence, polydipsia develop due to a decrease in the concentrating ability of the kidneys due to a violation of active sodium transport, which occurs with the participation of Na-K-ATPase, from the ascending knee of the nephron loop into the interstitium and sodium leaching from the medulla, as a result of which the cortico-medullary sodium gradient decreases and the reabsorption of osmotically free water is disturbed. At the same time, the water permeability of the distal tubules and collecting ducts decreases. A decrease in the volume of extracellular fluid enhances the reabsorption of bicarbonate and promotes the development of metabolic alkalosis, and an increase in secretion and excretion of potassium - hypokalemia

With long-term hypercalcemia, interstitial fibrosis is found in the kidneys with minimal changes in the glomeruli. Since intrarenal calcium concentration increases from the cortex to the papilla, with hypercalcemia, calcium crystals are precipitated mainly in the medulla, causing nephrocalcinosis and nephrolithiasis. Other clinical manifestations of kidney damage in hypercalcemia are urinary syndrome (moderate proteinuria, erythrocyturia), prerenal azotemia due to dehydration, acute renal failure and chronic renal failure as an outcome of obstructive pyelonephritis.

Diagnosis of Hypercalcemia

The first step in any unclear case of hypercalcemia is to measure the PTH to confirm or exclude a pHPT diagnosis. Along with the determination of iPTH, new measurement methods have recently appeared using specific aminoterminal antibodies. (Biointact-PTH, whole PTH). Application of PTH-Fragment-Assays obsolet.

Other conditions that support the diagnosis of pHPT are hypophosphatemia, high normal or high levels of 1.25 (OH) 2D3 (with a normal level of 25 (OH) D3), increased bone alkaline phosphatase, decreased to low normal renal calcium excretion (as a result of increased renal PTH action and increased renal "calcium-Loads") and high renal phosphate excretion (however, largely dependent on diet). Before the first parathyroidectomy, the diagnosis of the localization of enlarged epithelial bodies may be limited to neck ultrasonography, which determines the indicated condition in two-thirds of cases.

FHH (Heterozygous inactivating mutation Calcium-sensing-Rezeptors) occurs at a frequency of 1: 15,000-20,000. Based on laboratory chemistry results, it cannot be confidently distinguished from pHPT. Rather, the typical conditions for FHH are mild hypercalcemia and severe hypocalciu- nia; specificity is however limited. Screening by a family member for hypercalcemia and hypocalciuria may help with diagnosis. The diagnosis can be made with certainty only at the moment when the question is scientifically raised when using the Calcium-Sensing-Rezeptor-Gens sequencing. The distinction from pHPT is therefore of great importance, as FHH can generally be regarded as a no therapy anomaly and unnecessary parathyroid surgery is not performed on affected patients.

It is assumed that about 70-80% of tumor-associated hypercalcemias are humorally mediated. Most of these forms of hypercalcemia are based on the secretion of PTHrP from tumor tissue (often squamous cell carcinomas, such as renal carcinoma, bronchial carcinoma, and others). In the diagnosis of unclear hypercalcemia, one of the next steps is also the measurement of PTHrP.

Hematologic malinomas (plasmacytoma, lymphoma) usually do not produce PTHrP. In case of incomprehensible hypercalcemia, using appropriate diagnostic measures (immunoelectrophoresis, as a mandatory study for any hypercalcemia, bone marrow puncture, radiological examination of the skeleton), plasmacytoma should be excluded. Plasmacytomas and lymphomas secrete cytokines (interleukin-1, tumor necrotizing factor a), which, through the activation of osteoclasts, lead to hypercalcemia. The systematic identification of these cytokines has no clinical significance.

If a tumor is suspected, a search program should be carried out with a thorough clinical examination (e.g. lymphoma, suspected skin changes, breast tumor, prostate enlargement), tumor serum markers, Haemoccult, chest x-ray (volumetric process), abdominal sonography (metastases liver, kidney tumors) and radiological studies of the skeleton (scintiography, X-ray targeted images, detection of bone metastases, osteolysis, DD to pHPT, Morbus Paget).

For diagnostic clarification of incomprehensible hypercalcemia, a measurement of 1.25 (OH) 2D3 is performed. In rare cases, hypercalcemia can be caused by elevated levels of 1,25 (OH) 2D3. This most often indicates granulomatous diseases (most often sarcoidosis, less often tuberculosis and other diseases, see Table 2). Very rarely, ectopic lymphomas secrete 1,25 (OH) 2D3.

Treatment of Hypercalcemia

Treatment of hypercalcemia: elimination of the cause of hypercalcemia (removal of the tumor, stopping the intake of vitamin D, etc.), reducing the intake of calcium into the body, increasing its excretion, prescribing agents that prevent the release of calcium from the bones, and drugs that increase the flow of calcium into the bones. The most important component of treatment is the restoration of the volume of extracellular fluid. - 3 liters of isotonic sodium chloride solution per day under the control of central venous pressure) and correction of the electrolyte composition of the plasma. Furosemide enhances calcium excretion (100-200 mg intravenously every 2 hours), while thiazides have the opposite effect. Intravenous administration of phosphates (Na2 HPO4 or NaH2PO4) also decreases plasma calcium levels, but phosphates are contraindicated in renal impairment. Bone resorption is inhibited by calcitonin, glucocorticosteroids. The decrease in plasma calcium levels begins within a few hours after administration and reaches a maximum on the 5th day of treatment. Mitramycin causes thrombocytopenia, liver damage, and should be used if other treatment fails. For an urgent decrease in the calcium content in the blood, it is possible to use hemodialysis or peritoneal dialysis with calcium-free dialysis solution (in practice, it is used mainly in patients with concomitant heart and renal failure). In tumor hypercalcemia associated with excessive production of PGE 2 (metabolites are found in the urine), indomethacin and other inhibitors of prostaglandin synthesis give a hypocalcemic effect. Hypercalcemia accompanying thyrotoxicosis is quickly relieved by the administration of intravenous propranolol at a dose of 10 mg / h. Glucocorticosteroids have no effect on hypercalcemia in primary hyperparathyroidism, therefore, the hydrocortisone test is used for the differential diagnosis of hypercalcemia.

Hypercalcemia in Latin means "excess calcium in the blood." It is a syndrome of high plasma or serum calcium.

Calcium is perhaps the most common inorganic element that plays an important role in the life of the body.

What is hypercalcemia? It is not an independent disease, but a syndrome that develops in various diseases and for various reasons. This pathology is much less common than hypocalcemia, and is determined by conventional biochemical analysis.

Note. In adults, such a violation warns of the presence of serious diseases, but in children it may indicate an overdose of drugs.

There is a gradation of hypercalcemia in degrees:

In medical practice, there is also a disease such as hypercalciuria. What it is? Hypercalciuria - an increase in the amount of calcium in the urine, a consequence of hypercalcemia, occurs with vitamin D intoxication, bone destruction, sarcoidosis, Burnett's syndrome. In addition, hypercalciuria may appear with neoplasms of the kidneys and bronchi.

The indicator of calcium in the blood has a constant value in the body. An increase in calcium concentration negatively affects the kidney tubules, the ability of which to concentrate urine decreases. As a result, a lot of urine is released, and as a result, blood calcium rises even more. What causes hypercalcemia?

Factors provoking the development of the syndrome

The pathologies that contribute to the appearance of the syndrome contribute to the depletion of bone tissue (resorption). The causes of hypercalcemia are:

• oncological diseases of various organs;
• excess in the body of vitamin D;
• prolonged immobility;
• adrenal insufficiency;
• diseases of the parathyroid glands (primary hyperparathyroidism);
• uncontrolled intake of certain medications, etc.

The most common cause of hypercalcemia is the dominance of bone resorption over their formation, which leads to the development of secondary osteoporosis (pathological fragility of the skeleton with an increased risk of fractures).

How does the syndrome manifest?

Symptoms of hypercalcemia are often absent. Occasionally, there are clinical signs such as:

• increased blood pressure;
• constipation;
• nausea, vomiting;
• pain in the intestines;
• decreased appetite, dramatic weight loss.

An increase in calcium concentration is also characterized by the development of depression, emotional instability, delirium, and hallucinations. In addition to the signs of hypercalcemia, dehydration combined with persistent thirst can join.

Note. Often, patients complain of pain in the joints and bones. Actually, this gives the doctor a reason to prescribe an examination and identify hypercalcemia.

There are two types of hypercalcemia: true and false. It is important not to confuse these syndromes. The pseudo-disease is characterized by an increase in the level of albumin in the blood plasma, which is the reason for the increase in total calcium, i.e. development of hypercalcemia. Usually, these two conditions are distinguished by analysis: the level of free calcium in a real syndrome is critically increased, and in the case of a "false" variant, it does not exceed the normal range.

Calcium imbalance in children

Hypercalcemia in children is a rather rare biochemical disorder characterized by a powerful excretion of calcium from the bones, while the kidneys and gastric tract are practically inactive in this process.

There are several reasons for the development of the syndrome in babies:

• prematurity;
• transmission of the disease from the mother;
• lack of phosphorus;
• excessive concentration of vitamin D, etc.

Important! Parents, if you experience vomiting, inability to suck, constipation, muscle hypotonia, and weight loss, your child may have symptoms of mild hypercalcemia. It is necessary to consult a doctor to clarify the diagnosis.

Hypercalcemia in the vast majority of children is detected by chance, since it can develop asymptomatically and disappear on its own by one year. Excess calcium caused by inappropriate medication is treated with diet. But other complex forms of hypercalcemia are corrected only by surgery.

Idiopathic hypercalcemia

With an increased concentration of calcium in the blood, the newborn is diagnosed with idiopathic hypercalcemia. The disease is hereditary and is characterized by metabolic disorders, physical and mental underdevelopment, often in combination with heart disease. This form of the disease causes the child to develop kidney failure. It is associated with a pathologically increased sensitivity to vitamin D, which is inherited.

Signs of idiopathic hypercalcemia - elf face, mental retardation

Calcium excess therapy

Treatment of hypercalcemia (as well as osteoporosis) is pathogenetic in nature and depends on the causes that caused it. The directions of therapy are to stop the release of calcium from the bone tissue; reduce the intake of calcium into the body; enhance its excretion through the kidneys.

With malignant tumors and blood diseases, the primary task is to cure the main serious ailment, for which surgical intervention is also used.

Hypercalcemia caused by excess vitamin D intake can be eliminated by withdrawing it.

In case of hyperparathyroidism, the patient is operated on by removing the parathyroid gland.

Conclusion

Try to control your intake of calcium-rich foods. Not everyone needs this and is useful. And even more so, without the permission of the pediatrician, do not "stuff" your beloved children with such seemingly necessary vitamin D. Wisdom to you in matters of health!

Quite often, the condition develops as a result of the progression of oncological processes of the breast and bronchi, myeloma, endocrinopathies (hyperthyresis,), renal failure, taking certain medications, genetic pathologies, exceeding the dose of vitamin D.

The pathology is either asymptomatic, or characterized by erased symptoms... It is important not only to detect hypercalcemia in time, but also to determine its cause. Differential diagnosis of the causes of this condition is carried out in the course of clinical trials. At the same time, it is important to understand the mechanisms that are involved in the regulation of calcium levels in the blood, as well as the nature of their violation in case of pathological changes in the body.

Despite a wide range of causes of hypercalcemia, its manifestations are fairly common. Late diagnosis and delayed treatment can lead to the development of difficult to stop complications, up to renal failure. Therefore, it is important to regularly conduct an examination, including the determination of the level of calcium in the blood for the timely diagnosis of the pathological condition and the adoption of therapeutic measures.

Causes

The etiological factors of hypercalcemia include:

• oncological processes;
• humoral disorders;
• osteolysis with metastases in bone tissue and myelomas;
• drug influence (thiazides, lithium drugs);
• excess doses of vitamin D;
• immobilization;
• genetic causes (familial hypercalcemia, accompanied by hypocalciuria);
• infections;
• pheochromocytoma-type endocrinopathy.

The wide range of causes that can cause hypercalcemia determines some of the difficulties in making the correct diagnosis and in prescribing adequate treatment. Therefore, if hypercalcemia is detected a number of additional studies are assigned to identify the etiological factor. This allows you to accurately determine the primary disease and make the correct diagnosis.

In this case, therapeutic measures will also be most effective and will allow to level fluctuations in the level of calcium in the blood in a short time.

Symptoms

The state of hypercalcemia in oncological processes is due to metastatic destruction of bone tissue, as well as excessive synthesis of prostaglandin E2, which triggers bone resorption. In addition, osteoclasts are activated with the help of a factor synthesized by leukocytes and parathyroid hormone.

Acute provokes hypercalcemia as a result of resorptive processes in muscle tissues, as well as enhancing the synthesis and secretion of vitamin D metabolites in the cells of the kidney tissue.

Thiazides are able to enhance the reabsorption of calcium by the lining of the renal tubules. Hypercalcemia occurs as a result of an increase in the concentration of the vitamin D metabolite and due to increased absorption of calcium ions in the digestive system. Prolonged immobilization provokes the release of calcium from the bone tissue.

As a result of an increase in the concentration of calcium in the blood, spasm of arterioles, a decrease in renal blood supply and the process of glomerular filtration can be provoked. Besides, the process of reabsorption of potassium is inhibited, magnesium and sodium, increases the absorption of bicarbonate. The excretion of hydrogen ions and calcium ions is also enhanced.

Symptoms of hypercalcemia are mainly due to impaired renal function.

The clinical manifestations of hypercalcemia include:

• fatigue;
• polyuria;
• dyspeptic disorders;
• an increase in blood pressure in the early stages;
• hypotonic manifestations or collapse as the process progresses;
• lethargy.

Chronic condition of hypercalcemia does not have pronounced symptoms... The symptom of polyuria is associated with a decrease in the concentrating function of the renal tissue due to the pathology of active transport of sodium ions. Also, this decreases the reabsorption of water and the gradient of sodium ions, worsens the permeability of the tubules. Due to a decrease in the amount of extracellular fluid, the absorption of bicarbonate ions is enhanced, which provokes an increase in metabolic alkalosis. In addition, the release of potassium ions increases, which provokes the progression of the symptoms of hypokalemia.

Prolonged hypercalcemia causes the development of fibrosis of the interstitial... In this case, changes in the glomeruli will be minimal. Since the intrarenal content of calcium ions increases in the direction from the cortex to the papilla, the precipitation of crystalline calcium is mostly found in the medulla. This condition provokes nephrocalcinosis and nephrolithiasis.

Also to the clinical manifestations of renal symptoms include urinary syndrome, which includes erythrocyturia and mild proteinuria, prerenal azotemia, and renal failure resulting from obstructive inflammation.

The spectrum of clinical manifestations of hypercalcemia determines the complexity of differential diagnosis of the causes of this condition. Therefore, it is advisable for a one-time detection of an increase in calcium concentration to prescribe a range of additional studies that will make it possible to accurately diagnose and prescribe an effective therapy aimed at eliminating the cause of the pathological condition with high accuracy.

Diagnostics

Hypercalcemia often discovered by chance on a biochemical blood test... If it is detected, an additional study of parathyroid hormone is prescribed to detect dysfunction of the parathyroid glands. Often, with an increase in calcium in the blood, an increase in the activity of alkaline phosphatase is also determined. In addition, hypocalciuria is noted.

In some cases, hypercalcemia is triggered by a mutation in the calcium receptor gene. In this case, measures of molecular genetic diagnostics are carried out to clarify the etiological factor. Often this condition does not need therapy, and correct diagnosis can save the patient from irrational parathyroidectomy.

It is also rational to prescribe neck ultrasonography, bone marrow puncture, radiography to exclude oncological and other causes. Determination of serological markers of oncology and scintiography is possible.

The appointment of a study of the level of vitamin D metabolites is considered rational. Its fluctuations are noted with, and other pathological conditions.

The set of diagnostic measures allows you to determine the cause of the pathology and prescribe the correct treatment to eliminate provoking factors.

Treatment

First of all, therapy for hypercalcemia is aimed at getting rid of the etiological factor. This can be a resection of the oncology focus, a decrease in the dose of vitamin D, a decrease in calcium intake, an increase in excretion, as well as taking medications that prevent the leaching of calcium from the bone tissue and increase its intake into the bone.

An important point is the restoration of the proper volume of extracellular fluid by injecting the required amount of physiological solution by infusion. Also diuretics are prescribed to enhance calcium excretion. Intravenous intake of phosphate ions helps to reduce calcium levels, but they should be used with caution to avoid impaired renal tissue function.

Removal of calcium from bone tissue prevents corticosteroids and. These agents have a lasting effect of lowering the calcium content in the blood. An urgent decrease in the level of calcium in the blood is achieved by using peritoneal or hemodialysis. It is also possible to prescribe inhibitors of prostaglandin synthesis.

The required course of therapy can only be prescribed by a highly qualified specialist. The correctness of the prescription of drugs is determined by timely diagnosis and the identification of factors provoking the pathology.

Prevention

As a preventive measure, it is worth regularly conduct surveys for the purpose of timely diagnosis of fluctuations in the level of calcium in the blood. In addition, it is worth adjusting diet and fluid intake.

It is also necessary to observe the dosage of the prescribed drugs so that the excess of some drugs could not affect the calcium level. It is necessary monitor your vitamin D intake.

It is important to promptly subject to therapy of conditions that can provoke the development of symptoms of hypercalcemia.

Forecast

With all therapeutic measures, the prognosis auspicious... Timely reduction of calcium levels will eliminate the manifestations of clinical symptoms. It is important to diagnose in time an increase in the concentration of calcium ions in the blood so that the prescribed treatment is effective.

Persistent hypercalcemia can lead to serious complications up to before renal failure, for relief of which dialysis may be required.

To avoid adverse consequences, regular preventive examinations and laboratory tests should be carried out.

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Violation of the normal functioning of the body in most cases is associated with a deficiency or excess of certain substances. Hypercalcemia (Latin - hypercalcaemid) is the Latin term for a disease associated with an increase in blood calcium. The signs of hypercalcemia are most often seen in adults, but children are also at risk. Due to the fact that this pathology is associated with a change in the biochemical composition of the blood, the main diagnostic measures are a blood test for the content of chemical elements and radiation diagnostics.

Hypercalcemia in children is more dangerous than the disease in an adult. Often the child feels well in the early stages of the development of the pathology, which complicates the diagnosis. Therefore, it is necessary to carry out regular examinations of the body in order to avoid serious consequences.

Hypercalcemia syndrome

Hypercalcemia syndrome, depending on the severity, is classified into 3 types:

1. Light (with this degree, the calcium content in the blood is below 3 mmol / l).
2. Moderately severe (blood calcium concentration 3-3.6 mmol / l).
3. Severe (from 3.6 mmol / L).

Hypercalcemia develops as a result of a rapid oncological process in the body or pathology of the thyroid gland. In the course of these diseases, bone resorption (washing out of bone tissue) is observed, due to which a large amount of calcium gradually enters the blood. You should carefully monitor the level of calcium in the blood if you are diagnosed with a malignant tumor:

1. Neoplasms in the lungs
2. Prostate cancer
3. Blood diseases
4. Mammary cancer
5. Multiple myeloma

Several other factors that can cause hypercalcemia:

• Familial hypocalciuric hypercalcemia.
• Congenital lactase deficiency, as a result of which kidney calcification develops in babies. The newborn begins to develop more slowly. The baby copes with hypercalcemia by introducing a lactose-free diet, but kidney calcification in this case remains.
• Prolonged immobilization.
• Hypervitaminosis D.
• Milk-alkaline syndrome.
• Hyperparathyroidism, resulting in increased bone resorption.

Familial hypocalciuric hypercalcemia is a rare disease. Pathology occurs as a result of a mutation that reduces the sensitivity of calcium-sensitive receptors, which is why it is necessary to maintain the calcium content in the blood at a higher level. Familial hypercalcemia may take several generations. Also, an increase in the concentration of calcium in the blood plasma can lead to idiopathic hypercalcemia - a fairly rare genetic disease, accompanied by metabolic disorders.

CAUTION: Hyperkialcemia has other causes! Don't confuse hypercalcemia with a simple increase in blood albumin levels that can occur with prolonged dehydration. In this case, the level of calcium in the blood remains at an acceptable level.

Hypercalcemia symptoms

Often, hypercalcemia does not have pronounced symptoms due to the main cause - nutrition. A person can suppress all symptoms for a long time by regulating his diet, and the disease is diagnosed with a routine blood test. If you find the following symptoms, you should immediately consult a doctor.

1. Weakness.
2. Depression.
3. Violation of orientation in space.
4. Impaired coordination.
5. Cardiac arrhythmia.
6. Nausea, vomiting.
7. A sharp increase in blood pressure.
8. Hallucinations, impaired consciousness.
9. Sudden cardiac arrest.
10. Pain in the lower abdomen that occurs immediately after eating.
11. Stool disorders.
12. Indigestion.
13. Excessive urination.
14. Convulsions.

Hypercalciuria

When people talk about hypercalcemia, they often turn to the topic of "hypercalciuria". These diseases are interrelated, since hypercalciuria is the excretion of more than three hundred milligrams of calcium in the urinary fluid in men and at least two hundred and fifty milligrams of calcium in the fairer sex.

If hypercalciuria proceeds without complications, then its symptoms are usually not diagnosed. But such cases are very rare, because hypercalciuria is the main cause of the formation of kidney stones (calculi), which are hard formations that make it difficult to urinate.

In severe cases, there is a discharge of blood along with urinary fluid. Hypercalciuria leads to renal colic, which develops when there is an unexpected obstruction in the path of urine flow. The attack begins after physical overstrain, intake of copious amounts of fluid. The pain begins to manifest itself in the lumbar region, moves along the ureter towards the bladder, sometimes shoots in the hypochondrium and abdomen. It is accompanied by frequent urge to urinate. The pain may not subside for a long time, in this case, the patient is injected with antispasmodics and analgesics, in a severe case, hospitalized.

Diagnostics

Diagnostic measures consist in conducting a complete medical examination of the body. To do this, take a general blood test and examine the content of free and total calcium in it. For the authenticity of the research results, the following rules should be observed:

1. 24 hours before the tests, strictly do not consume alcohol and alcohol-containing products.
2. Avoid physical exertion 2 days before the examination.
3. 4 days before the study, eliminate foods with a high concentration of calcium from the diet, because they can negatively affect the result.
4. For 10 hours, drink only water and not eat.

If signs of hypercalcemia are found, the patient is additionally examined.

Tumor hypercalcemia

Malignant hypercalcemia is observed in 20-30% of cancer patients. In this case, the symptoms appear sharply and are pronounced. The treatment is the regulation of the calcium content in the blood plasma with the help of drugs, combined with anticancer therapy.

Treatment

Hypercalcemia requires treatment that depends on the severity of the pathology. In mild stages, only the main cause is eliminated. At the same time, it is recommended to drink plenty of water to eliminate the threat of dehydration during the excretion of calcium through the kidneys. In severe stages, complex treatment is carried out, most often intravenously. It is based on diuretics.

CAUTION: The use of diuretics can cause the leaching of important chemical elements, therefore, when using them, you should carefully monitor the intake of nutrients by the body.

The most effective treatment is dialysis (a procedure that replaces kidney function), but it is used accordingly only in the most extreme cases if other methods do not help. In special cases, hormonal drugs are prescribed that regulate the calcium content in the blood.

WARNING: Do not self-medicate. Treatment with folk methods will give a negative result, and this only postpones the healing process indefinitely. In addition, it leads to complications: atrioventricular block, acute renal failure, coma.

Hypocalcemia

Hypercalcemia and hypocalcemia are interrelated, as improper treatment of one disease leads to the appearance of another. Hypocalcemia - a decrease in the calcium content in the blood plasma. Treatment of hypocalcemia is associated with the prescription of drugs containing calcium and, as a rule, vitamin D. It is important to consider the duration and intensity of treatment, therefore, only reliable specialists should be selected.

Prevention

Prevention consists in the timely detection of the disease, refusal from uncontrolled intake of medications and a balanced diet. If you follow all the recommendations, you can be sure that you will not allow this pathology to appear.

The insidiousness of many diseases lies in the absence of characteristic symptoms in the early stages of development, which makes it possible for the disease to develop unhindered, more and more suppressing the well-organized work of the body.

One of these insidious diseases is hypercalcemia, the course of which in the early stages most often has no characteristic signs. What is hypercalcemia, the symptoms of which are so difficult to recognize?

Definition, classification and reasons

What is hypercalcemia, many people learn by accident, during the examination.

Hypercalcemia refers to a chronic condition in which the level of calcium in the blood rises. It will not be difficult to identify the disease, for this it is necessary to donate blood for analysis. If the indicators of total and free calcium exceed the norm, namely 2.6 and 1.5 mmol / l, respectively, hypercalcemia is diagnosed.

The disease can take three forms:

• easy, when the indicators of total calcium do not exceed 3, and free - 2 mmol / l;
• average - the level of mmol / l significantly increases compared with the mild form, and is in the range of up to 3.5 - total calcium, and up to 2.5 - free;
• in severe hypercalcemia, the level of total and free calcium reaches a critical level and exceeds 3.5 and 2.5 mmol / l, respectively.

Oncological processes and pathological changes in functioning are the most common causes of hypercalcemia. Since they contribute to the resorption of bone tissue, the release of calcium ions into the blood increases.

Hypercalcemia can occur during oncological processes in organs such as the kidneys, ovaries, mammary glands, prostate gland, large intestine, lungs.

In addition, the disease can develop against the background of blood diseases: myeloma, leukemia.

In addition, the causes of hypercalcemia are:

• hypocalciuric hypercalcemia of a hereditary nature;
• lactase deficiency;
• adrenal insufficiency (chronic or acute);
• taking drugs such as theophylline, thiazide diuretics, lithium preparations for a long period;
• insufficient excretion of calcium in the urine, while its absorption in the small intestine increases;
• renal failure;
• thyrotoxicosis;
• immobilization lasting a long period;
• hypervitaminosis D.

Hypercalcemia - what is the danger?

Increased calcium levels negatively affect the functioning of the whole body. Pathological changes occur in the kidney tubules, which reduces their ability to concentrate urine.

Moderate hypercalcemia can disrupt the work of the heart, increasing its contractility, and severe disease, on the contrary, reduces the contractility of the heart muscle.

In addition, excess calcium causes an increase in blood pressure, arrhythmia. The most serious outcome of the disease can be cardiac arrest. Fortunately, this happens on very rare occasions.

The central nervous system is also negatively affected by an excess of calcium. The onset of the development of the disease can be expressed by mild symptoms:

• prostration;
• slight lethargy;
• depression;
• weakness.

Then, as the disease progresses, the symptomatology gradually grows up to complete disorientation in space. But there is also a great risk of coma.

It should be noted that there are cases when pseudohypercalcemia is mistaken for a true disease. Pseudohypercalcemia is characterized by elevated levels of ambulin, resulting in increased total calcium levels.

In most cases, this condition is preceded by a long course of multiple myeloma or dehydration. Distinguishing true hypercalcemia from pseudohypercalcemia is very simple. In the first case, the level of free calcium will also be above normal. But with pseudohypercalcemia, there will be no deviations in the level of free calcium.

Signs of hypercalcemia

It is already clear what hypercalcemia is. But how to recognize a disease and prevent it from progressing? As already mentioned, the insidiousness of the disease lies in the absence of manifestations at an early stage.

Thus, the chances of identifying mild hypercalcemia by symptoms are reduced to zero. Already when the disease becomes more severe, patients note the presence of symptoms of hypercalcemia, namely:

• prostration;
• weakness;
• depression;
• mild lethargy;
• loss of space;
• impairment of consciousness, which can cause coma.

Increased calcium levels can also cause disturbances in the functioning of the cardiovascular system:

• arrhythmia;
• increased blood pressure;
• cardiac arrest.

In case of damage to the urinary system, the amount of urine excreted increases. However, when the disease is already in advanced form, the opposite process occurs, the volume of urine excreted significantly decreases.

When hypercalcemia affects the digestive system, the patient experiences the following symptoms:

• violation of the stool (constipation is most often noted);
• loss of appetite, complete refusal of food by the patient is possible;
• in the left hypochondrium, especially after eating, pain occurs;
• attacks of nausea and vomiting.

The prolonged period of the course of hypercalcemia causes calcification of the kidney structures. This pathology is characterized by the deposition of calcium in the heart, stomach, lungs, blood vessels and skin.

The most dangerous condition is a hypercalcemic crisis. Its presence is accompanied by the following manifestations:

• nausea and uncontrolled vomiting;
• severe bouts of abdominal pain;
• increased body temperature;
• convulsions;
• confusion, which entails stupor and to whom.

The rapid development of a hypercalcemic crisis, unfortunately, often ends in death.

Hypercalcemia in childhood

The disease is characterized by a severe course in childhood and requires immediate treatment.

Hypercalcemia in children takes different forms, depending on the age of the child. Each form of the disease differs in the nature of its origin and, accordingly, in the approach to treatment.

Newborns in most cases are affected by Williams syndrome, or as it is also called in medicine, "idiopathic hypercalcemia."

Williams syndrome develops due to a congenital genetic mutation. The main signs of idiopathic hypercalcemia in a child are:

• a sudden slowdown in psychological development;
• changes in the skull occur in the facial region, as a result of which the so-called face of an elf is formed;
• gross vascular anomalies.

The peculiarity of idiopathic hypercalcemia is that over time it causes cognitive and intellectual impairment in the child.

The heterozygous familial type also belongs to congenital hypercalcemia. Its difference lies in the benign course and the difficulty of diagnosing the disease at the beginning of development, due to the absence of clinical signs.

The familial type of hypercalcemia is often detected during the routine examination of the child. This type of disease usually does not require treatment.

In turn, hypocalciuric hypercalcemia is an extremely dangerous condition and requires immediate treatment. Symptoms of this form of hypercalcemia appear almost immediately. The child has a congenital skeletal pathology, a sudden deterioration in the development of both mental and physical.

Since in most cases the disease is characterized by an unfavorable outcome, it is recommended that the child's parathyroid glands be removed immediately after delivery. Rehabilitation in this case is long and consists in taking vitamin D and calcium-containing preparations.

Diagnostics

The purpose of diagnosing hypercalcemia is not only to determine the disease, but also to establish the cause of its development.

The doctor can put a preliminary analysis on the basis of the clinical picture, comparing it with the presence of an oncological disease present in the anamnesis. However, it is impossible to make an accurate diagnosis by relying on these measures alone.

The patient is assigned an appropriate examination, which consists in donating blood to determine the level of free and total calcium.

In order to get the most accurate test results, the patient must follow some measures before taking the test:

• exclude alcohol the day before the analysis;
• remove calcium-containing foods from the diet at least three days in advance;
• exclude heavy physical activity per day;
• 8 hours before the analysis, exclude the intake of any food.

If the results show an increased calcium level, the specific cause of the hypercalcemia is identified. In this case, the patient will need an additional examination:

• urinalysis, which will determine how much calcium is excreted along with it. The analysis is also carried out in order to identify the Bens-Jones protein, or to exclude it;
• a blood test that will show the level of bone metabolism, as well as the presence;
• biochemical blood test, which focuses on kidney tests.

If the development of hypercalcemia occurred due to cancer, the level of phosphate in the patient's blood will be lowered, while the level of PTH, on the contrary, will increase. The calcium content in the urine, in the presence of an oncological process in the body, is normal or increases slightly.

When the cause of hypercalcemia is myeloma, Bence-Jones protein is present in the urine, and an increase in ESR in the blood also occurs. At the same time, the level of phosphates is normal.

In the diagnosis of hypercalcemia, instrumental methods are also used:

• bone x-rays;
• Ultrasound of the kidneys;
• electrocardiography;
• densitometry is used to diagnose osteoporosis.

Treatment

Two factors affect the treatment of hypercalcemia:

• blood calcium;
• for what reason the development of hypercalcemia occurred.

If the disease is mild, only the cause of its development is eliminated. During normal kidney function, it is recommended to drink more fluids. This will prevent dehydration as the excess calcium is excreted through the kidneys.

Treatment of severe hypercalcemia and the presence of disorders in the functioning of the kidneys and the brain involves intravenous fluid administration. The main drugs for the treatment of hypercalcemia are diuretics, such as Furosemide, which help the kidneys remove more calcium.

Dialysis is another safe and effective treatment, but its use is advisable only in severe cases, when other methods of treatment have failed.

In the case, a surgical method of treatment is used, which involves the removal of the parathyroid glands. This removes all of their tissue, which produces the hormone in excess. After surgery, hypercalcemia subsides in almost 90% of cases.

If the above methods of treatment do not bring the desired effect, hormonal drugs are used that slow down the process of calcium release from the bones.

The development of hypercalcemia due to a malignant disease greatly complicates the treatment process. If it is not possible to establish control over the spread of the tumor, then hypercalcemia can recur, regardless of the tactics of treatment.

If characteristic symptoms of hypercalcemia are detected, it is necessary to consult a general practitioner for a thorough examination.