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Hypercalcaemia

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molecules) is measured with immunoradiometric or immunochemoluminescent assay. Elevated (or high-normal) iPTH with high urine calcium/creatinine ratio (more than 0.03) is suggestive of primary hyperparathyroidism, usually accompanied by low serum phosphate. High iPTH with low urine calcium/creatinine
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Research has led to a better understanding of hypercalcemia in non-human animals. Often the causes of hypercalcemia have a correlation to the environment in which the organisms live. Hypercalcemia in house pets is typically due to disease, but other cases can be due to accidental ingestion of plants
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Once calcium is confirmed to be elevated, a detailed history taken from the subject, including review of medications, any vitamin supplementations, herbal preparations, and previous calcium values. Chronic elevation of calcium with absent or mild symptoms often points to primary hyperparathyroidism
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Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP (2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special
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Hypercalcemia of malignancy (cancer) is due to a variety of mechanisms. The two most common are humoral hypercalcemia of malignancy and local osteolytic hypercalcemia due to bony metastasis. Humoral hypercalcemia of malignancy involves the tumor releasing a hormone which increases calcium
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The goal of therapy is to treat the hypercalcaemia first and subsequently effort is directed to treat the underlying cause. In those with a calcium level above 13 mg/dL, calcium level that is rising rapidly or those with altered mental status, urgent treatment is required.
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after surgical neck exploration is the only way to avoid death. The diagnostic program should be performed within hours, in parallel with measures to lower serum calcium. Treatment of choice for acutely lowering calcium is extensive hydration and
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pathway leading to bone resorption and calcium release into the bloodstream. The massive release of calcium from bone metastasis and osteoclast activation usually overwhelms the kidney's ability to secrete calcium, thus leading to hypercalcemia.
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Hypercalcemia of malignancy usually portends a poor prognosis, and the medial survival is 25–52 days of its development. It has an incidence of 30% in those with cancer, and the prevalence is estimated to be about 2-3% in the United States.
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Due to its limited duration of action (it works for 48–96 hours, then efficacy decreases as the calcitonin receptors are downregulated) its use is limited to acute hypercalcemia as a bridge therapy until more long-term treatments can be
1076:(PTHrP) measurements (though not available in all labs). Elevated PTHrP is suggestive of malignancy. Normal PTHrP is suggestive of multiple myeloma, vitamin A excess, milk-alkali syndrome, thyrotoxicosis, and immobilisation. Elevated 1095:), with levels greater than 2.6 mmol/L defined as hypercalcaemia. Moderate hypercalcaemia is a level of 2.88–3.5 mmol/L (11.5–14 mg/dL) while severe hypercalcaemia is > 3.5 mmol/L (>14 mg/dL). 1564:
is favorable. Even if small amounts are ingested over long periods of time, the prolonged high levels of calcium ions have large negative effects on the animals. The issues these animals experience are muscle weakness, and
2617: 2655: 257:), with levels greater than 2.6 mmol/L defined as hypercalcemia. Those with a mild increase that has developed slowly typically have no symptoms. In those with greater levels or rapid onset, symptoms may include 739:, which causes further activation of osteoclast activity. The combination of PTHrP driven osteoclast activation and calcium reabsorption by the kidneys causes hypercalcemia associated with malignancy (humoral type). 2732: 2717: 1426:
causes a rapid rise in calcium ion levels. Calcium ion levels can remain high for weeks if untreated and lead to an array of medical issues. There are also cases of hypercalcemia reported due to dogs ingesting
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Bisphosphonates are used as a first line therapy for those with hypercalcemia of malignancy. They are used as both an acute therapy and are usually continued long term to prevent hypercalcemia.
681: 367:, intravenous bisphosphonate, in addition to treating the underlying cause. The evidence for furosemide use, however, is poor. In those with very high levels, hospitalization may be required. 937: 1064:. For those who has underlying malignancy, the cancers may be sufficiently severe to show up in history and examination to point towards the diagnosis with little laboratory investigations. 1895: 3153: 475:. Since calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers, increased calcium raises the threshold for depolarization. This results in decreased 2614: 2681: 2652: 1719:
circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution".
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levels does not show the true levels of ionised calcium. There is, however, controversy around the usefulness of corrected calcium as it may be no better than total calcium.
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may be useful. Hypercalcemia is relatively common. Primary hyperparathyroidism occurs in 1–7 per 1,000 people, and hypercalcaemia occurs in about 2.7% of those with cancer.
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If detailed history and examination does not narrow down the differential diagnoses, further laboratory investigations are performed. Intact PTH (iPTH, biologically active
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or similar substances that cause rises in calcium ion levels. Hypercalcemia is most common in grazing lands at altitudes above 1500 meters where growth of plants like
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activity, respectively. Osteoclasts are a type of bone cell which cause bone resorption, releasing calcium into the bloodstream. PTHrP also acts by activating
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therapy can correct the hypophosphataemia in the face of hypercalcaemia and lower serum calcium, but this can further increase the risk for kidney stones and
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of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain
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Gruenberg MS, PhD, DECAR DECBHM. W.G., April 2014. Enzootic Calcinosis. The Merck Veterinary Manual. Merck Sharp & Dohme, Whitehouse Station, NJ, USA.
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Peterson DVM, DACVIM. M. E., July 2013. Hypercalcemia in Dogs and Cats. The Merck Veterinary Manual. Merck Sharp & Dohme, Whitehouse Station, NJ, USA.
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increased salt intake also can increase body fluid volume as well as increasing urine sodium excretion, which further increases urinary calcium excretion.
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Khan DVM, MS, PhD, DABVT, S.A., March 2012. Topical Agents (Toxicity). The Merck Veterinary Manual. Merck Sharp & Dohme, Whitehouse Station, NJ, USA.
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Solid tumor with metastasis via local osteolytic hypercalcemia: which can be due to any tumor that metastasizes to the bone. But common causes include
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can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to
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A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/L).
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which cause the onset of hypercalcemia. Consuming small amounts of these plants can be fatal to pets. Observable symptoms may develop such as
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can be given to permit continued large volume intravenous salt and water replacement while minimizing the risk of blood volume overload and
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are the main causes of hypercalcemia, but there are also environmental causes usually unique to indoor pets. Ingestion of small amounts of
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is the initial therapy. Hypercalcemia usually causes symptoms that lead to chronic dehydration, such as nausea, vomiting, anorexia, and
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effective in hypercalcemia due to malignancy with elevated vitamin D levels (many types of malignancies raise the vitamin D level).
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In certain outdoor environments, animals such as horses, pigs, cattle, and sheep experience hypercalcemia commonly. In southern
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Household pets such as dogs and cats are found to develop hypercalcemia. It is less common in cats, and many feline cases are
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Bisphosphonates caused normalization of calcium levels in 60-90% of patients who were treated for hypercalcemia of malignancy.
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blocks bone resorption by inhibiting osteoclasts and also increases urinary calcium excretion by the kidneys.
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of blood vessels, heart valves, liver, kidneys, and other soft tissues, which eventually can lead to death.
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is suggestive of lymphoma, sarcoidosis, granulomatous disorders, and excessive calcitriol intake. Elevated
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Minisola S, Pepe J, Piemonte S, Cipriani C (2015). "The diagnosis and management of hypercalcaemia".
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Usually used in life-threatening hypercalcaemia along with rehydration, diuresis, and bisphosphonates
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Denosumab caused normalization of calcium levels in 70% in those with hypercalcemia of malignancy.
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ratio is suggestive of familial hypocalciuric hypercalcemia. Low iPTH should be followed up with
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tend to depress calcium reabsorption by the kidney thereby helping to lower blood calcium levels
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cream. Additionally, ingestion of household plants is a cause of hypercalcemia. Plants such as
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and inhibit osteoclastic bone resorption, therefore inhibiting calcium release from osteoclasts
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may be used in those who do not respond to other treatments. In those with vitamin D toxicity,
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Causes of hypercalcemia can be divided into those that are PTH dependent or PTH independent.
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suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute
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is a bone anti-resorptive agent that can be used to treat hypercalcemia in patients with a
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at Medscape. Author: Robin R Hemphill. Chief Editor: Erik D Schraga. Retrieved April 2011
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is dried out, the toxicity of it is diminished. Other plants causing hypercalcemia are
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Current Medical Diagnosis and Treatment 2007 (Current Medical Diagnosis and Treatment)
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Another mechanism in which cancer causes hypercalcemia is via local osteolysis due to
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Medical and Surgical Treatment of Parathyroid Diseases: An Evidence-Based Approach
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An Osborn wave, an abnormal EKG tracing that can be associated with hypercalcemia.
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Common cancer types that are associated with hypercalcemia of malignancy include:
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Mitchell, Richard Sheppard, Kumar, Vinay, Abbas, Abul K., Fausto, Nelson (2007).
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or chemicals in the home. Outdoor animals commonly develop hypercalcemia through
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Denosumab is a monoclonal antibody that inhibits osteoclasts. It acts by binding
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or those who are severely dehydrated as they may worsen or cause kidney disease.
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analogues with high affinity for bone, especially areas of high bone-turnover.
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Sekine O, Hozumi Y, Takemoto N, Kiyozaki H, Yamada S, Konishi F (March 2004).
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increase urinary calcium excretion and decrease intestinal calcium absorption
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level and be confirmed after a week. This is because either high or low serum
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Guise TA, Wysolmerski JJ (14 April 2022). "Cancer-Associated Hypercalcemia".
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inhibits bone resorption and changes structure of bone crystals (rarely used)
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level and be confirmed after a week. Specific changes, such as a shortened
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Tierney, Lawrence M., McPhee, Stephen J., Papadakis, Maxine A. (2006).
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Amazon Sapira's Art & Science of Bedside Diagnosis (Kindle Edition)
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Hypercalcemia of malignancy may also occur due to tumor production of
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The neuromuscular symptoms of hypercalcaemia are caused by a negative
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no effect on calcium level in normal or primary hyperparathyroidism
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Principles and practice of palliative care and supportive oncology
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to bone. Tumor bone metastasis releases local cytokines including
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and malignancy account for about 90% of cases of hypercalcaemia.
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In extreme cases of primary hyperparathyroidism, removal of the
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Lippincott Williams & Wilkins. Retrieved January 7, 2012.
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to bisphosphonates such as severe kidney failure or allergy.
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Journal of Community Hospital Internal Medicine Perspectives
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is suggestive of vitamin D or excessive calcifediol intake.
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Diagnosis should generally include either a calculation of
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of ovarian small cell carcinoma of the hypercalcemic type.
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Roenn, Jamie H. Von, Ann Berger, Shuster, John W. (2007).
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in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds)
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effect due to the increased interaction of calcium with
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Ovarian small cell carcinoma of the hypercalcemic type
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usually used in severe hypercalcaemia complicated by
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Solid tumor with humoral mediation of hypercalcemia:
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Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP.
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Abnormal clinical and laboratory findings for blood
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Hypercalcaemia has also been known to cause an 719:on the kidneys and bones and causes an increased 600:The main symptoms of a hypercalcaemic crisis are 3695: 2368: 2162: 2160: 2158: 2156: 2154: 2152: 1422:found in psoriasis cream can be fatal to a pet. 2220:Cancer Management: A Multidisciplinary Approach 1831:Proceedings of the National Academy of Sciences 1319:rarely used, or used in special circumstances: 522:occurs as a result, manifestations can include 3235:Neurodegeneration with brain iron accumulation 2426: 2364: 2362: 2360: 2358: 2356: 2354: 2352: 2350: 2348: 2346: 2344: 2342: 2340: 2166: 1976: 1974: 1972: 1970: 1818: 1760:"Hypercalcemia - National Library of Medicine" 1285:preventing it from activating osteoclasts via 332:. Diagnosis should generally include either a 3421: 3147: 2854: 2453: 2338: 2336: 2334: 2332: 2330: 2328: 2326: 2324: 2322: 2320: 2149: 1824: 1794:Principles and Practice of Geriatric Medicine 3435: 2430:Nutrition Therapy for Chronic Kidney Disease 1390:from wild plants within their environments. 843:(especially squamous cell tumors, a type of 27:High calcium (Ca2+) level in the blood serum 1967: 1886: 1884: 1882: 1880: 1131:finding mimicking hypothermia, known as an 32:For the disorder of low blood calcium, see 3428: 3414: 3154: 3140: 2868: 2861: 2847: 2317: 1651: 1649: 1647: 1645: 1643: 1641: 1639: 1637: 1635: 1633: 1631: 1629: 723:reabsorption of calcium and activation of 60: 2582: 2533: 2184: 2132: 1998: 1980: 1860: 1850: 1754: 1752: 1750: 1627: 1625: 1623: 1621: 1619: 1617: 1615: 1613: 1611: 1609: 914:and other granulomatous diseases such as 557:Symptoms are more common at high calcium 2169:"Hypercalcemia: etiology and management" 2063:(8th ed.). Philadelphia: Saunders. 1877: 1787: 1785: 1713: 1711: 1709: 1707: 1705: 1703: 1701: 1699: 1697: 1695: 1474: 1102: 796: 592: 296:. Other causes of hypercalcemia include 3162:Metal deficiency and toxicity disorders 2559:"Osborn waves in a hypothermic patient" 1147: 653: 14: 3696: 3628:Acrokeratosis paraneoplastica of Bazex 3509:Paraneoplastic cerebellar degeneration 1747: 1606: 1325:inhibits bone resorption (rarely used) 886: 3409: 3135: 2842: 2557:Serafi SW, Vliek C, Taremi M (2012). 2167:Renaghan AD, Rosner MH (2018-04-01). 2121:Japanese Journal of Clinical Oncology 2051: 1782: 1770:from the original on 8 September 2017 1692: 949: 682:Familial isolated hyperparathyroidism 378: 318:familial hypocalciuric hypercalcaemia 3491:Nonbacterial thrombotic endocarditis 2956:Familial hypocalciuric hypercalcemia 2506:Wesson L, Suresh V, Parry R (2009). 2244:The Lecturio Medical Concept Library 2090:. McGraw-Hill Professional. p.  1935:The Lecturio Medical Concept Library 1467:, extreme fatigue, or constipation. 1062:Familial hypocalciuric hypercalcemia 938:Idiopathic hypercalcaemia of infancy 695:Familial hypocalciuric hypercalcemia 446:Muscle weakness, decreased reflexes 3072:Hypokalemic sensory overstimulation 2412:Online Mendelian Inheritance in Man 2309:Online Mendelian Inheritance in Man 2294:Online Mendelian Inheritance in Man 2279:Online Mendelian Inheritance in Man 2264:Online Mendelian Inheritance in Man 2173:Nephrology Dialysis Transplantation 1955:Hypercalcemia in Emergency Medicine 1733:10.1016/j.resuscitation.2010.08.015 1074:Parathyroid hormone-related protein 709:parathyroid hormone-related protein 249:. The normal range is 2.1–2.6  24: 3486:Multicentric reticulohistiocytosis 1898:from the original on July 13, 2017 1470: 1313: 514:, abdominal pain, & paralytic 25: 3730: 3539:Lambert–Eaton myasthenic syndrome 2695: 2454:Stack BC Jr, Bodenner DL (2016). 2209:"Thyroid and Parathyroid Cancers" 1431:containing a chemical similar to 1393: 1190:caution must be taken to prevent 1087:The normal range is 2.1–2.6  986: 288:Most outpatient cases are due to 1380: 932:granulomatosis with polyangiitis 585:or coma. In the gut this causes 3669:Febrile neutrophilic dermatosis 3638:Florid cutaneous papillomatosis 3544:Anti-NMDA receptor encephalitis 3048:Hyperkalemic periodic paralysis 2916:Disorders of calcium metabolism 2550: 2499: 2488:from the original on 2014-12-16 2482:"Life in the Fast Lane • LITFL" 2474: 2447: 2427:Thomas LK, Othersen JB (2016). 2420: 2405: 2371:New England Journal of Medicine 2302: 2287: 2272: 2257: 2232: 2201: 2108: 2015: 1594:Disorders of calcium metabolism 768:macrophage inflammatory protein 717:parathyroid hormone 1 receptors 667:Primary parathyroid hyperplasia 3119:Cerebral salt-wasting syndrome 3067:Hypokalemic periodic paralysis 2615:Hypercalcemia in Dogs and Cats 2240:"Multiple Endocrine Neoplasia" 1948: 1923: 1910: 1522:before it has dried out. Once 1205:Bisphosphonates and calcitonin 1163:nephrogenic diabetes insipidus 1091:(8.8–10.7 mg/dL, 4.3–5.2 697:/familial benign hypercalcemia 620:should be proved or excluded. 253:(8.8–10.7 mg/dL, 4.3–5.2 13: 1: 3600:Necrolytic migratory erythema 1825:Armstrong CM, Cota G (1999). 1599: 1138: 1035:Excessive calcium consumption 942:Rebound hypercalcaemia after 616:. After recognition, primary 581:, confusion, hallucinations, 3633:Extramammary Paget's disease 3375:Acrodermatitis enteropathica 2526:10.7861/clinmedicine.9-2-186 1916:Orient, Dr. Jane M. (2011). 1039: 993:Tertiary hyperparathyroidism 707:mobilization (most commonly 676:Multiple endocrine neoplasia 663:Solitary parathyroid adenoma 659:Primary hyperparathyroidism 554:may be visible in the eyes. 550:. Calcium deposits known as 494:(especially in those taking 310:multiple endocrine neoplasia 175:level > 2.6 mmol/L ( 157:multiple endocrine neoplasia 7: 3395:Inborn errors of metabolism 2921:Hypercalcemia of malignancy 1981:Ziegler R (February 2001). 1796:. Vol. 2. 2005. i–ii. 1572: 1412:primary hyperparathyroidism 645:Primary hyperparathyroidism 292:and inpatient cases due to 290:primary hyperparathyroidism 137:Primary hyperparathyroidism 10: 3735: 3463:Zollinger–Ellison syndrome 3213:African iron overload/HFE4 2433:. CRC Press. p. 116. 1026:Zollinger–Ellison syndrome 845:non-small cell lung cancer 437:excessive urination volume 31: 3661: 3608: 3584: 3575: 3552: 3499: 3476: 3443: 3387: 3363: 3343: 3334: 3301: 3276: 3267: 3243: 3176: 3167: 3082: 3033: 3010: 2987: 2964: 2876: 2784: 2703: 2679:Topical Agents (Toxicity) 2575:10.3402/jchimp.v1i4.10742 1048:or direct measurement of 701: 639: 224: 214: 187: 166: 132: 112: 88: 76: 68: 59: 51: 46: 3704:Electrolyte disturbances 3679:Paraneoplastic pemphigus 3437:Paraneoplastic syndromes 2950:Dystrophic calcification 2946:Metastatic calcification 2460:. Springer. p. 99. 2000:10.1681/ASN.V12suppl_1s3 1802:10.1002/047009057X.app01 1009: 965:Prolonged immobilization 895:(vitamin D intoxication) 715:in that it binds to the 461:, cognitive dysfunction 3595:Erythema gyratum repens 3567:Hypertrophic osteopathy 3322:Occipital horn syndrome 2061:Robbins Basic Pathology 1589:Electrolyte disturbance 1556:. These plants contain 490:Other symptoms include 2870:Electrolyte imbalances 1983:"Hypercalcemic crisis" 1852:10.1073/pnas.96.7.4154 1485: 1261:chronic kidney disease 1108: 1098: 906:(see calcitriol under 851:of the head and neck, 809: 737:nuclear factor kappa B 593:Hypercalcaemic crisis 384:Mnemonic for symptoms 355:Treatment may include 2383:10.1056/NEJMcp2113128 1535:Nierembergia veitchii 1478: 1223:they are taken up by 1171:after rehydration, a 1125:myocardial infarction 1115:can also result, and 1106: 1021:Adrenal insufficiency 849:squamous cell cancers 800: 671:Parathyroid carcinoma 451:Psychiatric overtones 421:non-specific symptoms 411:Abdominal discomfort 279:abnormal heart rhythm 123:abnormal heart rhythm 3674:Pyoderma gangrenosum 3623:Ichthyosis acquisita 3618:Acanthosis nigricans 3198:Hemochromatosis/HFE1 2911:Milk-alkali syndrome 1209:Additional therapy: 1148:Fluids and diuretics 1119:findings of a short 1004:Milk-alkali syndrome 859:, and breast cancer. 654:Parathyroid function 477:deep tendon reflexes 348:, may be seen on an 3534:Transverse myelitis 3519:Limbic encephalitis 2895:Symptoms and signs 2653:Enzootic Calcinosis 2134:10.1093/jjco/hyh028 1987:J. Am. Soc. Nephrol 1843:1999PNAS...96.4154A 1562:Trisetum flavescens 1553:Solanum malacoxylon 1524:Trisetum flavescens 1519:Trisetum flavescens 1481:Trisetum flavescens 1448:Solanum malacoxylon 1234:, (2nd generation) 1069:parathyroid hormone 887:Vitamin-D disorders 788:parathyroid hormone 713:parathyroid hormone 618:hyperparathyroidism 565:: at these levels, 524:increased urination 492:cardiac arrhythmias 385: 330:hydrochlorothiazide 69:Calcium within the 3648:Pityriasis rotunda 3468:Cushing's syndrome 3220:Aceruloplasminemia 2785:External resources 2684:2014-07-28 at the 2658:2014-07-28 at the 2620:2014-07-28 at the 2225:2013-10-04 at the 2214:2010-02-28 at the 2186:10.1093/ndt/gfy054 2027:2017-09-08 at the 1993:(Suppl 17): S3–9. 1960:2011-04-25 at the 1579:Calcium metabolism 1486: 1484:(yellow oat grass) 1388:vitamin D toxicity 1348:hypervitaminosis D 1346:also effective in 1109: 950:High bone-turnover 893:Hypervitaminosis D 857:urothelial cancers 810: 760:interleukin-1 beta 678:(MEN1 & MEN2A) 528:urination at night 383: 379:Signs and symptoms 357:intravenous fluids 314:vitamin D toxicity 245:(Ca) level in the 193:intravenous fluids 191:Underlying cause, 161:vitamin D toxicity 3719:Medical mnemonics 3691: 3690: 3687: 3686: 3643:Leser-TrĂ©lat sign 3514:Encephalomyelitis 3403: 3402: 3383: 3382: 3330: 3329: 3313:Copper deficiency 3263: 3262: 3129: 3128: 2836: 2835: 2513:Clinical Medicine 2467:978-3-319-26794-4 2440:978-1-4398-4950-7 2377:(15): 1443–1451. 2101:978-0-07-147247-0 2070:978-1-4160-2973-1 2044:978-0-7817-9595-1 1811:978-0-470-09057-2 1670:10.1136/bmj.h2723 1408:Addison's disease 1246:(3rd generation) 1152:Initial therapy: 1046:corrected calcium 1031:Williams Syndrome 625:parathyroid gland 563:medical emergency 520:kidney impairment 465: 464: 350:electrocardiogram 334:corrected calcium 232: 231: 177:corrected calcium 168:Diagnostic method 41:Medical condition 16:(Redirected from 3726: 3582: 3581: 3430: 3423: 3416: 3407: 3406: 3368: 3348: 3341: 3340: 3306: 3293:Wilson's disease 3281: 3274: 3273: 3248: 3225:Atransferrinemia 3181: 3174: 3173: 3156: 3149: 3142: 3133: 3132: 2936:Calcinosis cutis 2863: 2856: 2849: 2840: 2839: 2701: 2700: 2689: 2676: 2663: 2650: 2625: 2612: 2597: 2596: 2586: 2554: 2548: 2547: 2537: 2503: 2497: 2496: 2494: 2493: 2478: 2472: 2471: 2451: 2445: 2444: 2424: 2418: 2409: 2403: 2402: 2366: 2315: 2306: 2300: 2291: 2285: 2276: 2270: 2261: 2255: 2254: 2252: 2250: 2236: 2230: 2205: 2199: 2198: 2188: 2164: 2147: 2146: 2136: 2112: 2106: 2105: 2081: 2075: 2074: 2055: 2049: 2048: 2019: 2013: 2012: 2002: 1978: 1965: 1952: 1946: 1945: 1943: 1941: 1927: 1921: 1914: 1908: 1907: 1905: 1903: 1894:. Merck Manual. 1888: 1875: 1874: 1864: 1854: 1822: 1816: 1815: 1789: 1780: 1779: 1777: 1775: 1756: 1745: 1744: 1715: 1690: 1689: 1653: 1541:Solanum esuriale 1502:Papua New Guinea 1373:nephrocalcinosis 1276:contraindication 1181:pulmonary oedema 961:Multiple myeloma 910:) levels (e.g., 870:multiple myeloma 735:which activates 532:increased thirst 512:loss of appetite 483:), and skeletal 386: 382: 64: 44: 43: 21: 3734: 3733: 3729: 3728: 3727: 3725: 3724: 3723: 3694: 3693: 3692: 3683: 3657: 3604: 3571: 3562:Dermatomyositis 3554:Musculoskeletal 3548: 3495: 3472: 3439: 3434: 3404: 3399: 3379: 3364: 3359: 3344: 3326: 3302: 3297: 3288:Copper toxicity 3277: 3259: 3255:Iron deficiency 3244: 3239: 3193:Hemochromatosis 3177: 3163: 3160: 3130: 3125: 3078: 3029: 3006: 2983: 2960: 2872: 2867: 2837: 2832: 2831: 2780: 2779: 2712: 2698: 2693: 2692: 2686:Wayback Machine 2677: 2666: 2660:Wayback Machine 2651: 2628: 2622:Wayback Machine 2613: 2600: 2555: 2551: 2504: 2500: 2491: 2489: 2480: 2479: 2475: 2468: 2452: 2448: 2441: 2425: 2421: 2410: 2406: 2367: 2318: 2307: 2303: 2292: 2288: 2277: 2273: 2262: 2258: 2248: 2246: 2238: 2237: 2233: 2227:Wayback Machine 2216:Wayback Machine 2206: 2202: 2165: 2150: 2113: 2109: 2102: 2082: 2078: 2071: 2057:Table 20-4 in: 2056: 2052: 2045: 2029:Wayback Machine 2020: 2016: 1979: 1968: 1962:Wayback Machine 1953: 1949: 1939: 1937: 1931:"Hypercalcemia" 1929: 1928: 1924: 1915: 1911: 1901: 1899: 1892:"Hypercalcemia" 1890: 1889: 1878: 1823: 1819: 1812: 1791: 1790: 1783: 1773: 1771: 1758: 1757: 1748: 1727:(10): 1400–33. 1716: 1693: 1654: 1607: 1602: 1575: 1529:Cestrum diurnum 1473: 1471:Outdoor animals 1457:cholecalciferol 1442:Cestrum diurnum 1396: 1383: 1335:glucocorticoids 1329:gallium nitrate 1316: 1314:Other therapies 1214:bisphosphonates 1207: 1183:. In addition, 1150: 1141: 1101: 1050:ionized calcium 1042: 1012: 989: 969:Paget's disease 956:Hyperthyroidism 952: 928:Crohn's disease 903: 889: 733:osteoprotegerin 731:and inhibiting 704: 656: 642: 634:bisphosphonates 595: 485:muscle weakness 473:sodium channels 381: 338:ionized calcium 237:, also spelled 181:ionized calcium 42: 37: 28: 23: 22: 15: 12: 11: 5: 3732: 3722: 3721: 3716: 3711: 3706: 3689: 3688: 3685: 3684: 3682: 3681: 3676: 3671: 3665: 3663: 3659: 3658: 3656: 3655: 3650: 3645: 3640: 3635: 3630: 3625: 3620: 3614: 3612: 3610:Papulosquamous 3606: 3605: 3603: 3602: 3597: 3591: 3589: 3579: 3573: 3572: 3570: 3569: 3564: 3558: 3556: 3550: 3549: 3547: 3546: 3541: 3536: 3531: 3526: 3521: 3516: 3511: 3505: 3503: 3497: 3496: 3494: 3493: 3488: 3482: 3480: 3474: 3473: 3471: 3470: 3465: 3460: 3455: 3453:Hypercalcaemia 3449: 3447: 3441: 3440: 3433: 3432: 3425: 3418: 3410: 3401: 3400: 3398: 3397: 3391: 3389: 3385: 3384: 3381: 3380: 3378: 3377: 3371: 3369: 3361: 3360: 3358: 3357: 3351: 3349: 3338: 3332: 3331: 3328: 3327: 3325: 3324: 3318:Menkes disease 3315: 3309: 3307: 3299: 3298: 3296: 3295: 3290: 3284: 3282: 3271: 3265: 3264: 3261: 3260: 3258: 3257: 3251: 3249: 3241: 3240: 3238: 3237: 3232: 3227: 3222: 3217: 3216: 3215: 3210: 3205: 3200: 3190: 3184: 3182: 3171: 3165: 3164: 3159: 3158: 3151: 3144: 3136: 3127: 3126: 3124: 3123: 3122: 3121: 3116: 3111: 3101: 3100: 3099: 3097:Salt poisoning 3088: 3086: 3080: 3079: 3077: 3076: 3075: 3074: 3069: 3059: 3058: 3057: 3056: 3055: 3039: 3037: 3031: 3030: 3028: 3027: 3022: 3016: 3014: 3008: 3007: 3005: 3004: 2999: 2993: 2991: 2985: 2984: 2982: 2981: 2976: 2970: 2968: 2962: 2961: 2959: 2958: 2953: 2939: 2925: 2924: 2923: 2913: 2908: 2907: 2906: 2904:Trousseau sign 2901: 2893: 2888: 2882: 2880: 2874: 2873: 2866: 2865: 2858: 2851: 2843: 2834: 2833: 2830: 2829: 2827:Hypercalcaemia 2818: 2801: 2789: 2788: 2786: 2782: 2781: 2778: 2777: 2766: 2755: 2744: 2729: 2713: 2708: 2707: 2705: 2704:Classification 2697: 2696:External links 2694: 2691: 2690: 2664: 2626: 2598: 2549: 2498: 2473: 2466: 2446: 2439: 2419: 2404: 2316: 2301: 2286: 2271: 2256: 2231: 2229:. 11 ed. 2008. 2200: 2179:(4): 549–551. 2148: 2107: 2100: 2076: 2069: 2050: 2043: 2014: 1966: 1947: 1922: 1909: 1876: 1817: 1810: 1781: 1746: 1691: 1604: 1603: 1601: 1598: 1597: 1596: 1591: 1586: 1584:Dent's disease 1581: 1574: 1571: 1547:Solanum torvum 1492:and Mattewara 1472: 1469: 1453:ergocalciferol 1416:kidney failure 1414:, and chronic 1395: 1394:Household pets 1392: 1382: 1379: 1378: 1377: 1376: 1375: 1366: 1363:kidney failure 1356: 1355: 1354: 1344: 1341: 1332: 1326: 1315: 1312: 1311: 1310: 1309: 1308: 1304: 1295: 1294: 1293: 1290: 1269: 1268: 1267: 1264: 1257: 1254: 1228: 1206: 1203: 1202: 1201: 1200: 1199: 1188: 1185:loop diuretics 1169: 1166: 1149: 1146: 1140: 1137: 1100: 1097: 1041: 1038: 1037: 1036: 1033: 1028: 1023: 1018: 1011: 1008: 1007: 1006: 1001: 995: 988: 987:Kidney failure 985: 984: 983: 977: 971: 966: 963: 958: 951: 948: 947: 946: 944:rhabdomyolysis 940: 935: 924:histoplasmosis 901: 896: 888: 885: 884: 883: 880: 860: 837: 703: 700: 699: 698: 692: 686: 685: 684: 679: 673: 668: 665: 655: 652: 641: 638: 594: 591: 571:cardiac arrest 463: 462: 452: 448: 447: 444: 440: 439: 430: 424: 423: 419:Complaints of 417: 413: 412: 409: 405: 404: 401: 397: 396: 390: 380: 377: 344:and prolonged 283:cardiac arrest 259:abdominal pain 239:hypercalcaemia 230: 229: 226: 222: 221: 218: 212: 211: 189: 185: 184: 170: 164: 163: 134: 130: 129: 127:cardiac arrest 116: 110: 109: 95:Abdominal pain 92: 86: 85: 80: 74: 73: 71:periodic table 66: 65: 57: 56: 55:Hypercalcaemia 53: 49: 48: 40: 26: 9: 6: 4: 3: 2: 3731: 3720: 3717: 3715: 3712: 3710: 3707: 3705: 3702: 3701: 3699: 3680: 3677: 3675: 3672: 3670: 3667: 3666: 3664: 3660: 3654: 3651: 3649: 3646: 3644: 3641: 3639: 3636: 3634: 3631: 3629: 3626: 3624: 3621: 3619: 3616: 3615: 3613: 3611: 3607: 3601: 3598: 3596: 3593: 3592: 3590: 3588: 3583: 3580: 3578: 3577:Mucocutaneous 3574: 3568: 3565: 3563: 3560: 3559: 3557: 3555: 3551: 3545: 3542: 3540: 3537: 3535: 3532: 3530: 3527: 3525: 3522: 3520: 3517: 3515: 3512: 3510: 3507: 3506: 3504: 3502: 3498: 3492: 3489: 3487: 3484: 3483: 3481: 3479: 3478:Hematological 3475: 3469: 3466: 3464: 3461: 3459: 3456: 3454: 3451: 3450: 3448: 3446: 3442: 3438: 3431: 3426: 3424: 3419: 3417: 3412: 3411: 3408: 3396: 3393: 3392: 3390: 3386: 3376: 3373: 3372: 3370: 3367: 3362: 3356: 3355:Zinc toxicity 3353: 3352: 3350: 3347: 3342: 3339: 3337: 3333: 3323: 3319: 3316: 3314: 3311: 3310: 3308: 3305: 3300: 3294: 3291: 3289: 3286: 3285: 3283: 3280: 3275: 3272: 3270: 3266: 3256: 3253: 3252: 3250: 3247: 3242: 3236: 3233: 3231: 3230:Hemosiderosis 3228: 3226: 3223: 3221: 3218: 3214: 3211: 3209: 3206: 3204: 3203:Juvenile/HFE2 3201: 3199: 3196: 3195: 3194: 3191: 3189: 3188:Iron overload 3186: 3185: 3183: 3180: 3175: 3172: 3170: 3166: 3157: 3152: 3150: 3145: 3143: 3138: 3137: 3134: 3120: 3117: 3115: 3112: 3110: 3107: 3106: 3105: 3102: 3098: 3095: 3094: 3093: 3090: 3089: 3087: 3085: 3081: 3073: 3070: 3068: 3065: 3064: 3063: 3060: 3054: 3051: 3050: 3049: 3046: 3045: 3044: 3041: 3040: 3038: 3036: 3032: 3026: 3023: 3021: 3018: 3017: 3015: 3013: 3009: 3003: 3000: 2998: 2995: 2994: 2992: 2990: 2986: 2980: 2977: 2975: 2972: 2971: 2969: 2967: 2963: 2957: 2954: 2951: 2947: 2943: 2942:Calcification 2940: 2937: 2933: 2932:Calciphylaxis 2929: 2926: 2922: 2919: 2918: 2917: 2914: 2912: 2909: 2905: 2902: 2900: 2899:Chvostek sign 2897: 2896: 2894: 2892: 2889: 2887: 2884: 2883: 2881: 2879: 2875: 2871: 2864: 2859: 2857: 2852: 2850: 2845: 2844: 2841: 2828: 2824: 2823: 2819: 2817: 2814: 2811: 2807: 2806: 2802: 2800: 2796: 2795: 2791: 2790: 2787: 2783: 2776: 2772: 2771: 2767: 2765: 2761: 2760: 2756: 2754: 2750: 2749: 2745: 2743: 2739: 2738: 2734: 2730: 2728: 2724: 2723: 2719: 2715: 2714: 2711: 2706: 2702: 2687: 2683: 2680: 2675: 2673: 2671: 2669: 2661: 2657: 2654: 2649: 2647: 2645: 2643: 2641: 2639: 2637: 2635: 2633: 2631: 2623: 2619: 2616: 2611: 2609: 2607: 2605: 2603: 2594: 2590: 2585: 2580: 2576: 2572: 2568: 2564: 2560: 2553: 2545: 2541: 2536: 2531: 2527: 2523: 2519: 2515: 2514: 2509: 2502: 2487: 2483: 2477: 2469: 2463: 2459: 2458: 2450: 2442: 2436: 2432: 2431: 2423: 2417: 2413: 2408: 2400: 2396: 2392: 2388: 2384: 2380: 2376: 2372: 2365: 2363: 2361: 2359: 2357: 2355: 2353: 2351: 2349: 2347: 2345: 2343: 2341: 2339: 2337: 2335: 2333: 2331: 2329: 2327: 2325: 2323: 2321: 2314: 2310: 2305: 2299: 2295: 2290: 2284: 2280: 2275: 2269: 2265: 2260: 2245: 2241: 2235: 2228: 2224: 2221: 2217: 2213: 2210: 2204: 2196: 2192: 2187: 2182: 2178: 2174: 2170: 2163: 2161: 2159: 2157: 2155: 2153: 2144: 2140: 2135: 2130: 2126: 2122: 2118: 2111: 2103: 2097: 2093: 2089: 2088: 2080: 2072: 2066: 2062: 2054: 2046: 2040: 2036: 2030: 2026: 2023: 2018: 2010: 2006: 2001: 1996: 1992: 1988: 1984: 1977: 1975: 1973: 1971: 1963: 1959: 1956: 1951: 1936: 1932: 1926: 1919: 1913: 1897: 1893: 1887: 1885: 1883: 1881: 1872: 1868: 1863: 1858: 1853: 1848: 1844: 1840: 1837:(7): 4154–7. 1836: 1832: 1828: 1821: 1813: 1807: 1803: 1799: 1795: 1788: 1786: 1769: 1765: 1764:PubMed Health 1761: 1755: 1753: 1751: 1742: 1738: 1734: 1730: 1726: 1722: 1721:Resuscitation 1714: 1712: 1710: 1708: 1706: 1704: 1702: 1700: 1698: 1696: 1687: 1683: 1679: 1675: 1671: 1667: 1663: 1659: 1652: 1650: 1648: 1646: 1644: 1642: 1640: 1638: 1636: 1634: 1632: 1630: 1628: 1626: 1624: 1622: 1620: 1618: 1616: 1614: 1612: 1610: 1605: 1595: 1592: 1590: 1587: 1585: 1582: 1580: 1577: 1576: 1570: 1568: 1567:calcification 1563: 1559: 1555: 1554: 1549: 1548: 1543: 1542: 1537: 1536: 1531: 1530: 1525: 1521: 1520: 1515: 1511: 1507: 1503: 1499: 1495: 1491: 1483: 1482: 1477: 1468: 1466: 1462: 1458: 1454: 1450: 1449: 1444: 1443: 1438: 1434: 1433:calcipotriene 1430: 1425: 1424:Calcipotriene 1421: 1420:calcipotriene 1417: 1413: 1409: 1405: 1404:lymphosarcoma 1401: 1391: 1389: 1381:Other animals 1374: 1370: 1367: 1364: 1360: 1357: 1353: 1349: 1345: 1342: 1339: 1338: 1336: 1333: 1330: 1327: 1324: 1321: 1320: 1318: 1317: 1305: 1302: 1301: 1299: 1296: 1291: 1288: 1284: 1280: 1279: 1277: 1273: 1270: 1265: 1262: 1258: 1255: 1253: 1249: 1245: 1241: 1237: 1233: 1229: 1226: 1222: 1221: 1219: 1218:pyrophosphate 1215: 1212: 1211: 1210: 1197: 1193: 1189: 1186: 1182: 1178: 1174: 1173:loop diuretic 1170: 1167: 1164: 1160: 1157: 1156: 1155: 1154: 1153: 1145: 1136: 1134: 1130: 1126: 1122: 1118: 1114: 1113:heart rhythms 1105: 1096: 1094: 1090: 1085: 1083: 1079: 1075: 1070: 1065: 1063: 1057: 1055: 1051: 1047: 1034: 1032: 1029: 1027: 1024: 1022: 1019: 1017: 1014: 1013: 1005: 1002: 999: 996: 994: 991: 990: 981: 978: 975: 972: 970: 967: 964: 962: 959: 957: 954: 953: 945: 941: 939: 936: 933: 929: 925: 921: 917: 913: 909: 905: 897: 894: 891: 890: 881: 879: 875: 871: 867: 864: 861: 858: 854: 853:kidney cancer 850: 846: 842: 838: 835: 831: 827: 826:kidney cancer 823: 819: 818:breast cancer 815: 814: 813: 807: 806:H&E stain 803: 799: 795: 791: 789: 785: 780: 777: 773: 769: 765: 761: 757: 753: 749: 745: 740: 738: 734: 730: 726: 722: 718: 714: 710: 696: 693: 690: 687: 683: 680: 677: 674: 672: 669: 666: 664: 661: 660: 658: 657: 651: 648: 646: 637: 635: 632:, as well as 631: 626: 621: 619: 615: 611: 608:, as well as 607: 603: 598: 590: 588: 584: 580: 576: 572: 568: 564: 560: 555: 553: 549: 545: 541: 537: 533: 529: 525: 521: 517: 513: 509: 505: 501: 497: 493: 488: 486: 482: 478: 474: 470: 460: 456: 453: 450: 449: 445: 442: 441: 438: 434: 431: 429: 426: 425: 422: 418: 415: 414: 410: 407: 406: 402: 399: 398: 394: 391: 388: 387: 376: 374: 370: 369:Haemodialysis 366: 362: 358: 353: 351: 347: 343: 339: 335: 331: 327: 323: 319: 315: 311: 307: 306:Paget disease 303: 299: 295: 291: 286: 284: 280: 276: 275:kidney stones 272: 268: 264: 261:, bone pain, 260: 256: 252: 248: 244: 240: 236: 235:Hypercalcemia 227: 223: 219: 217: 213: 210: 206: 202: 198: 194: 190: 186: 182: 178: 174: 171: 169: 165: 162: 158: 154: 153:Paget disease 150: 146: 142: 138: 135: 131: 128: 124: 120: 119:Kidney stones 117: 115: 114:Complications 111: 108: 104: 100: 97:, bone pain, 96: 93: 91: 87: 84: 83:Endocrinology 81: 79: 75: 72: 67: 63: 58: 54: 50: 47:Hypercalcemia 45: 39: 35: 30: 19: 18:Hypercalcemia 3529:Polymyositis 3501:Neurological 3452: 3365: 3345: 3303: 3278: 3245: 3178: 2885: 2820: 2803: 2792: 2768: 2757: 2746: 2731: 2716: 2569:(4): 10742. 2566: 2562: 2552: 2520:(2): 186–7. 2517: 2511: 2501: 2490:. Retrieved 2476: 2456: 2449: 2429: 2422: 2407: 2374: 2370: 2304: 2289: 2274: 2259: 2247:. Retrieved 2243: 2234: 2203: 2176: 2172: 2127:(3): 155–8. 2124: 2120: 2110: 2086: 2079: 2060: 2053: 2034: 2017: 1990: 1986: 1950: 1938:. Retrieved 1934: 1925: 1912: 1900:. Retrieved 1834: 1830: 1820: 1793: 1774:27 September 1772:. Retrieved 1763: 1724: 1720: 1661: 1657: 1561: 1551: 1545: 1539: 1533: 1527: 1523: 1517: 1487: 1479: 1446: 1440: 1429:rodenticides 1397: 1384: 1208: 1151: 1142: 1110: 1086: 1066: 1058: 1043: 1000:intoxication 982:intoxication 916:tuberculosis 868:: including 811: 792: 781: 741: 705: 649: 643: 622: 599: 596: 587:constipation 575:hypotonicity 559:blood values 556: 489: 481:hyporeflexia 469:bathmotropic 466: 433:Constipation 354: 320:and certain 302:tuberculosis 287: 241:, is a high 238: 234: 233: 209:hemodialysis 149:tuberculosis 38: 34:Hypocalcemia 29: 3653:Tripe palms 3366:deficiency: 3304:deficiency: 3246:deficiency: 2794:MedlinePlus 1402:. 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Index

Hypercalcemia
Hypocalcemia

periodic table
Specialty
Endocrinology
Symptoms
Abdominal pain
confusion
depression
weakness
Complications
Kidney stones
abnormal heart rhythm
cardiac arrest
Primary hyperparathyroidism
cancer
sarcoidosis
tuberculosis
Paget disease
multiple endocrine neoplasia
vitamin D toxicity
Diagnostic method
Blood serum
corrected calcium
ionized calcium
intravenous fluids
furosemide
calcitonin
pamidronate

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