Hypercalcemia

Elevated serum calcium level greater than 10.5 mg/dL

Definition

Hypercalcemia is a serum total calcium concentration greater than 10.5 mg/dL (or ionized calcium >5.2 mg/dL). Severe hypercalcemia (>14 mg/dL) is a medical emergency.

Causes

Hyperparathyroidism (most common outpatient)
Malignancy (most common inpatient: bone metastases, multiple myeloma, lung/breast cancer)
Excessive vitamin D or calcium intake
Thiazide diuretics
Immobilization
Sarcoidosis, TB

Signs and Symptoms (Mnemonic: Stones, Bones, Groans, Moans, Thrones)

Kidney stones, bone pain, abdominal pain/constipation, psychiatric changes, and polyuria, such as also muscle weakness, shortened QT interval, cardiac arrhythmias.

Nursing Interventions

IV normal saline (forced saline diuresis) + loop diuretics (furosemide). Bisphosphonates (zoledronic acid), calcitonin. Dialysis for refractory cases (encourage ambulation). Avoid calcium supplements and thiazides. Monitor ECG.

NCLEX Relevance

Mnemonic: Stones, Bones, Groans, Moans. IV saline first.