Hypercalcemia history and symptoms

The symptoms of hypercalcemia are same irrespective of etiology. Neurological symptoms are common in hypercalcemia as normal neurological processes requires optimal serum extracellular concentration. The patient may have a positive history of kidney stones, bone pain and tenderness, gastrointestinal symptoms. “Bones, stones, groans, and psychic moans” is a saying which may help remember the signs and symptoms of hypercalcemia.

The symptoms of hypercalcemia are same irrespective of etiology. Neurological symptoms are common in hypercalcemia as normal neurological processes requires optimal serum extracellular concentration.^[1]

Although majority of patients with hypercalcemia have non-specific history but a detailed and thorough history from the patient is necessary. The patient may have a positive history of:^[2]

• Kidney stones
• Bone pain and tenderness
• Fragile bones of the limbs and spine that can break easily
• Frequent and excessive urination
• Gastrointestinal symptoms like epigastric pain, constipation, indigestion, nausea, and vomiting
• Feeling tired, ill, and weak
• Depression and memory disturbances
• Vitamin D deficiency
• Chronic renal failure in case secondary hyperparathyroidism is suspected
• Renal transplant in case tertiary hyperparathyroidism is suspected
• Use of medications including thiazide diuretics and lithium.
• Neck radiation

• “Bones, stones, groans, and psychic moans” is a saying which may help remember the signs and symptoms of hypercalcemia. Abnormal heart rhythms can result, and EKG findings of a short QT interval and a widened T wave suggest hypercalcemia.^[3]
• Symptoms are more common at high calcium blood values (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.

Hypercalcemia may result in:^[4]

• Fatigue
• Depression
• Confusion
• Anorexia
• Nausea
• Vomiting
• Constipation
• Pancreatitis
• Increased urination

• Renal stones
• Headaches
• Bone pain and/or weakness
• Abdominal pain
• Confusion
• Nausea/vomiting
• Constipation
• Peptic ulcer disease
• Hallucinations
• Bradycardia
• Insulin resistance
• Glucose intolerance
• Muscle weakness
• Hyporeflexia
• Polyuria
• Pancreatitis
• Psychosis
• Depression
• Anxiety
• Constipation
• Decreased libido
• Hypertension
• Heart palpitations which are often due to bouts of atrial fibrillation
• Gastroesophageal reflux
• Lack of concentration
• Loss of appetite
• Left ventricular hypertrophy
• Polydipsia
• Thinning of hair

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