Harrison's Practice: Hypercalcemia

Hypercalcemia

Definition

An elevation of the serum calcium levels > 2.6 mmol/L (>10.5 mg/dL)
- Mild hypercalcemia
  - Serum calcium level of 2.6–3.0 mmol/L (10.5–12 mg/dL)
  - Often asymptomatic and noted on routine calcium measurements
- Moderate hypercalcemia
  - Serum calcium of 3.0–3.2 mmol/L (12–13 mg/dL)
  - May see symptoms of lethargy, anorexia, polyuria, GI distress, weakness, altered mental status
- More severe hypercalcemia
  - Serum calcium level ≥3.2 mmol/L (≥13 mg/dL)
  - Often a medical emergency
  - May result in stupor and coma, renal stones, and progressive GI symptoms (nausea, constipation, pancreatitis)
  - Levels above 15 mg/dL can cause life-threatening cardiac rhythm disturbances.
Only free (ionized) calcium is biologically active.
- Because about half of circulating calcium is bound to albumin, a patient with hypoalbuminemia may be hypercalcemic despite normal total calcium levels.
- To compensate and more accurately assess the calcium level, adjust the calcium level upward 0.8 mg/dL for every 1.0 g/dL of albumin below 4.1 g/dL.

Hypercalcemia has been found in Harrison's Practice

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