Hypercalcaemia - Signs and Symptoms

Signs and Symptoms

There is a general mnemonic for remembering the effects of hypercalcaemia: "Stones, Bones, Groans, Thrones and Psychiatric Overtones"

• Stones (renal or biliary)
  
• Bones (bone pain)
  
• Groans (abdominal pain, nausea and vomiting)
  
• Thrones (sit on throne - polyuria)
  
• Psychiatric overtones (Depression 30-40%, anxiety, cognitive dysfunction, insomnia, coma)
  

Other symptoms can include fatigue, anorexia, and pancreatitis.

Abnormal heart rhythms can result, and ECG findings of a short QT interval and a widened T wave suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute myocardial infarction. Hypercalcaemia has also been known to cause an ECG finding mimicking hypothermia, known as an Osborn wave.

Hypercalcaemia can increase gastrin production, leading to increased acidity so peptic ulcers may also occur.

Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/l). Severe hypercalcaemia (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. Medical staff will recognise that panic attacks and hyperventilation cause hypocalcaemia and irritable, hypersensitive nerves with muscle cramping and tingling sensations. Hypercalcaemia causes the opposite - the high levels of calcium ions decrease neuronal excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. In the gut this causes constipation. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor and / or coma.