# Hypercalcemia --- **Hypercalcemia** is a condition where there is a dangerously high level of [[calcium]] in the blood. It's quite a dangerous condition, but our normal [[calcium#Calcium Regulation|calcium regulation]] system is generally good enough to prevent calcium from building up to these levels. Typically it is caused by some sort of disease or that disrupts this regulation. Hypercalcemia has about a 50% mortality, typically due to a cardiac standstill due to the buildup of calcium blocking the sodium [[channel proteins]] in the heart muscle itself. ## Causes The most common cause of hypercalcemia is a malignancy such as [[multiple myeloma]] or [[hyperparathyroidism]] that secretes and excess of [[parathyroid hormone]] (PTH) Additionally it can be cause by bone loss due to [[bed rest|immobility]] (like astronauts experience in microgravity) or an overuse of [[diuretics]] or [[glucocorticoids]]. Hypercalcemia can also be caused by an [[vitamin D]], which activates PTH (which pulls Ca++ out of the bones). ## Signs & Symptoms The most concerning sign of hypercalcemia is cardiac [[arrhythmia]], as well as muscle weakness and the formation of [[renal calculi]]. Hypercalcemia just slows things down, so a lot of the symptoms have to with the patient or their body just being really sleepy and slow Other symptoms include: - loss of appetite/anorexia - constipation - fatigue - confusion - pathological fractures (long term) - severe thirst - hypertension - bradycardia - [[venous thrombosis|deep vein thrombosis]] - remember calcium plays a role in coagulation ## Treatment Treatment for hypercalcemia largely involves treating the underlying cause and reversing the process. For example: - IV fluids to dilute the calcium - NS preferred - [[phosphate]] to bring down the calcium levels - [[diuretics|loop diuretics]] - triggers calcium loss in the urine - restricting dietary calcium - [[thyroid|calcitonin]] - severe hypercalcemia may be a canidate for [[dialysis]] ## Nursing Considerations Nursing care for patients with hypercalcemia involve: - monitoring heart rate/rhythm - monitoring for [[altered mental status]] - assessing for risk, especially for mobility and fluids - hypercalcemia aggravates [[glycosides|digitalis]] toxicity ___